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Home My WebLink AboutCAG2018-0352 - Supplement - Premier Motor Escort, LLC - Authorized Emergency Vehicle Permit Application - 09/21/2021 FOR CITY OF KENT OFFICIAL USE ONLY Sup/Mgr: Agreement Routing Form Dir Asst: • For Approvals,Signatures and Records Management Dir/Dep: KE N T This form combines&replaces the Request for Mayor's Signature and Contract Cover (Optional) WASHINGTON Sheet forms. Originator: Department: Jalene King Police Date Sent: Date Required: > 09/22/2021 0 i CL Authorized to Sign: Date of Council Approval: QDirector or Designee Budget Account Number: Grant?E]YesE]No N/A Budget?E]YesEl No Type: N/A Vendor Name: Category: Premier Motor Escort Application Vendor Number: Sub-Category: = Original 0 Project Name: Emergency Vehicle Application E c Project Details:authorized emergency vehicles _ a� E Agreement Amount: Basis for Selection of Contractor: Direct Negotiation *Memo to Mayor must be attached i Start Date: Termination Date: Im Q Local Business?F--]YesF--]No* If meets req uiremen ts per KCC 3.70.100,please complete'Vendor Purchase-Local Exceptions'form on Cityspace. Business License Verification:ElYes In-Process Exempt(KCC 5.01.045) Notice required prior to disclosure? Contract Number: CAG 2021-415 F1 Yes F1No Comments: _ :1w 3 0 d H •� i N 3 M = a1 V1 Date Routed to the City Clerk's Office: ac�emn3�i__ro Visit Documents.KentWA.gov to obtain copies of all agreements rev.20210513 AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION tw., 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) Premier Motor Escort, LLC. Address PO Box 55634 City Shoreline State WA Zip 98177-0634 Phone (206) 542-4763 E-mail PremierMotorEscort@comeast.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. Premier Motor Escort provides 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. RCW 46.37.194 WAC Chapter 204-36 WAC 308-330-466 WAC 204-36-050(3) 3000-323-006(R 6/15) Page 1 of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT 1 F LP %TAP[" APPLICATION WA$1 ig 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 2012 7G8660 ® SIREN Whelen A112 MAKE MODEL FX_j LAMP(S)(location/colors) HONDA ST1300P Front:Red/Clear Whelen 00+LINZ6 1. VIN Sides:Red/Clear Whelen 00+LINZ6 J JH2SC513XCK000014 Rear: Red Whelen 500+LINZ6+TIR3 REGISTERED OWNER ❑ OTHER EQUIPMENT: Rem I liflit 3ar: Red Whelen b4RRRR THOMAS P DeBARTOLO VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2009 5F4039 SIREN Whelen PA112 MAKE MODEL Z LAMP(S)(location/colors) HONDA ST1300P Front:Red/Clear Whelen 00+LINZ,6 / 2. VIN Sides: Red/Clear Whelen tOO+LlNZ6 `/ JH2SC51769K600684 Rear:Red Whelen 500+LINZ6+TIR3 REGISTERED OWNER [D OTHER EQUIPMENT: _Rear Lightbar:Red Whelen ,PrlRRRR THOMAS P DeBARTOLO Clear Strobe 3M U ticorn 79-111 VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2006 OG1243 SIREN Whelen ;SA314 MAKE MODEL Z LAMP(S)(location/colors) HONDA ST1300P Front:Red/Clear Whelen `0+LINZ6 3. VIN Sides:Red/Clear Whelen OO+LINZ6 JH2C51716M400294 Rear: Red Whelen 500+LINZ6+TIR3 REGISTERED OWNER Z OTHER EQUIPMENT: Rear Li htbar:Red Whelen RRRR THOMAS P DeBARTOLO Clear Strobe Nova PE VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 1999 4F4096 ® SIREN Whelen PA112 MAKE MODEL LAMP(S)(location/colors) Kawasaki KZ1000P Front: Red/Clear Whelen OO+TIR6 4. VIN Sides:Red/Clear Whelen 00+TIR6 JKAKZCPP25XB517259 _ Rear: Red Whelen 500 REGISTERED OWNER ❑ OTHER EQUIPMENT: Rear Liglltbar: Red whelen RRRR THOMAS P DeBARTOLO 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 2a of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT '.,"!Dh"'',, APPLICATION DWI :3 f. 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 2017 9208LEM SIREN Whelen IWPA112 MAKE MODEL LAMP(S)(location/colors) H-D FLHTP Front:Red/Clear Whelen 1LINZ6 Array 5- VIN Sides: Red/Clear Whelen 500+LIN3 IHDIFMC13HB643262 Rear:Red/Clear Whelen 500 REGISTERED OWNER OTHER EQUIPMENT: Clear Strobe Nova PE JULIUS PARNICZKY VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2017 7E8101 ® SIREN Whelen 15D21OR MAKE MODEL ® LAMP(S)(location/colors) H-D FLHTP Front:Red/Clear Whelen INZ6 Array 6• VIN Sides:Red/Clear Whelen OO+LIN3 1HDIFMCIXHB655974 Rear:Red/Clear Whelen 500 REGISTERED OWNER ® OTHER EQUIPMENT: Clear Strobe Nova PE JOHN HYBRIDGE VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2013 1J1285 SIREN Whelen PA112 MAKE MODEL LAMP(S)(location/colors) CanAm SPYDER Front:Red/Clear fame a nforcer/Flcx 7. VIN Sides: Red/Clear _ Cam Enforcer 2BXNCBC14DVO02916 Rear: Red/Amber Dame a Enforcer REGISTERED OWNER ❑ OTHER EQUIPMENT: VERN EARL JOHNSON JR VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2003 9G1709 SIREN Code 3 13R2 MAKE MODEL LAMP(S)(location/colors) BMW R1150 Front:Red Code 3 ED X 8• VIN Sides:Red Redtronic X31 WB10499A63ZE89539 bear:Red Code 3 LED X REGISTERED OWNER ❑ OTHER EQUIPMENT: Rear Pole Llit_Fled_ Whelen CRAIG HERKENHOFF 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 2b of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT G°b9 •+�%/4AGi 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 2017 9208LEM SIREN Whelen M'I'A112 MAKE MODEL LAMP(S)(location/colors) / H-D FLHTP Front:Red/Clear Whelen IN Arra V 5• VIN Sides: Red/Clear Whelen +LIN3 1HDIFMC13HB643262 Rear: RecKlear Whelen 1500 AN REGISTERED OWNER ® OTHER EQUIPMENT: Clear Strobe Nova JULIUS PARNICZKY II VEHICLE INFORMATION EMERGENCY EQU MENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2017 7E8101 ® SIREN Whelen "D21OR MAKE MODEL ® LAMP(S)(iocatia colors) H-D FLHTP Front:Red/Clear Whelen LINZ6 Array 6. VIN Sides:Red/Cie Whelen .4fl+LIN3 1HDIFMCIXHB655974 Rear:Red/C ar Whelen 500 REGISTERED OWNER OTHE EQUIPMENT: Clear St be _ Nova !CPF JOHN HYBRIDGE VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2013 8E1792 --;� C.Urrertt plai>° N.SIREN— Whelen IWPA112 MAKE MODEL [g LAMP(S)(location/colors) CanAm SPYDER Front:Red/Clear Dame a dorcer/Flex ✓ 7• VIN Sides: Red/Clear _ Damega nforccr 2BXNCBC14DVO02916 Rear:Red/Amber Damega Enforcer REGISTERED OWNER OTHER EQUIPMENT: VERN EARL JOHNSON JR VEHICLE INFORM/A I ION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE N INSTALLED MAKE MODEL 2003 9G1709 ® SIREN Code 3 13R2 MAKE MODEL LAMP(S)(location/colors) BMW R1150 Front:Red Code 3 Ell X_ 8• VIN Sides:Red Redtronic gX31 WB10499A63ZE89539 Rear:Red Code 3 LED X REGISTERED OWNER F1 OTHER EQUIPMENT: Rear Pot Light:_Rcd.. Whelen CRAIG HERKENHOFF 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 2b of 5 AUTHORIZED EMERGENCY VEHICLE PERMITI'll", '447 APPLICATION il 0-0 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 2006 4D9116 SIREN Whelen kAl12 MAKE MODEL LAMP(S)(location/colors) HONDA ST1300P Front:Red/Clear Whelen t+LINZ6 +LINZ6 J 9. VIN Sides:Red/Clear Whelen JH2SC51706M400268 Rear:Red Whelen 500+LINZ6+TIR3 REGISTERED OWNER ❑ OTHER EQUIPMENT: Rear Liehtb�ir: Red _ Whelen 4RRRR THOMAS P DeBARTOLO VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ❑SIREN _ MAKE MODEL ❑ LAMP(S)(location/colors) I 10 VIN REGISTERED OWNER ❑ OTHER EQUIPMENT: VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ❑ SIREN MAKE MODEL ❑ LAMP(S)(location/colors) 11 VIN REGISTERED OWNER ❑ OTHER EQUIPMENT: VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ❑ SIREN _ MAKE MODEL ❑ LAMP(S)(location/colors) 12 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 2c of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT x=xm ate_? 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 certified flagger, and carry their certified flagger card at all times. Name Driver's License Number Flagger Certification Number(if applicable—see WAC 204-36-040) New? Thomas P DeBartolo WDL45TPG243B 452575 -Expires: 03/2024 Anthony J DeBartolo WDL426N8253B 449486 -Expires: 10/2023 John Hybridge WDL6361F283B 426603 - Expires: 06/2022 Vernon Johnson WDL2R8R8483B 412081 - Expires: 01/2022 E-- C Julius Parniczky P652-420-64-426-0 (FL) 454431 - Expires: 05/2024 Craig Herkenhoff WDL31 S90G63B 415664 - Expires: 02/2023 ✓ Twyla R DeBartolo* WDLIB8NGD13B 437772 - Expires: 08/2023 V Christina R DeBartolo* WDL592T5263B 432082 -Expires: 08/2022 Catharine M Devine* WDL5BRPJD23B 408603 - Expires: 08/2021 *Provides Traffic Control Services only. 3000-323-006(R 8/15) Page 3 of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT hH aixi[ SH:L APPLICATION U.., fir 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) City of Kent ❑ 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. Signature Tort Dn EaktOGD _ Title Owner, Premier Motor Escort LLC. (CHIEF EXECUTIVE OFFICER) Name Tom DeBartolo Date 8/24/2021 (TYPE OR PRINT) 3000-323-006(R 8/15) Page 4 of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT N APPLICATION 4W 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 print: Signature ,.� Date Title Clk�L Name ' (Please Print) C�Z� .ivoi. _ Jurisdiction klevt Phone 9-3) riQ — SgCO E-Mail Restrictions Signature _ Date Title Name Jurisdiction (Please Print) Phone ( ) E-Mail Restrictions Signature Date Title Name Jurisdiction (Please Print) Phone ( ) E-Mail Restrictions Signature Date Title Name Jurisdiction (Please Print) — Phone ( ) E-Mail Restrictions Signature Date Title Name Jurisdiction (Please Print) Phone ( ) E-Mail Restrictions Signature Date _ Title Name Jurisdiction (Please Print) -- 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. 3000-323.006(R 8/15) Page 5 of 5