HomeMy WebLinkAboutCAG2011-1001 - Original - Northwest Motor Escort - Authorized Emergency Vehicle Permit (AEVP) - 05/27/2011STATE CIF 14/A5hiINCTON
GenenarAdmirrisrration Euirding " m::i#"*,:?,il,jffi5,Iiffi?,ir0) se6-4r)00 . www.wsp.wa.sov
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Mr. Tim Chiswell
Northwest Motor Escort
1915 Kibler Avenue
Enumcalw WA 9g022-3311
lfrf,ll pOUcE AEpARTI/tE$tf
Dear Mr. Chiswell:
The renewalAuthorized Emergency Vehicle Permit (AEVP) for Northwest Motor Escortis enclosed.
Please ensure a copy of the permit and the enclosed list of approved drivers arecarried in the vehiclb"at all times. '' rv vr rvrvos., rror' ul
ffyroximately
one month prior to the expiration date, a renewal form will be sent to
lf you have any questions prease cail Ms. Merissa Van Gorkom at (360) 596-4017.
CI{RISTINE CI. CRECCIIRE
Cgvernor
Sin
c tn nG
,OHN R. EATISTF
Chief
nta edia Relations
JGB:mvg
Enclosures
cc: Chief James Arsan_to, _Buckley police DepartmentChief Blackburn, Fife police Department
Captain Steve Burns, District 2 _ BellevueCaptain Jeff DeVere, District 1 _ TacomaChief Bret Farrar, Lakewood police DepartmentChief John Galle, Sumner police DepartmentCaptain Ken Ginnard, District 7 _ MarysvilleChief Andy Hwang, FederalWay Folice DepartmentCaptain Bob Johnson, District g'_ BremertonSheriff John Lovick, Snohomish County Sheriffs OfficeChief Linda pillo, Bellevue policsDepartment
Chief Ken Thomas, Kent police DepartmentMs. Melissa Van Gorkom, Equipment and StandardsChief Jim Zoll, Enumclaw poiici Department
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AUTHORIZED EMERGENCY VEHICLE PERMIT
APPLICATION RENEWAL
H,R.HMWtr
WASHINGTON STATE PATROL
EQUIPMENT & STANDARDS REVIEW UNIT
GENERAL ADMI N ISTRATION BLDG
PO BOX 42600
oLYMP|A WA 98504-2600
DATE APPROVED: May 27,2011
VALID UNTIL:
CAPTAIN
11 2012
or Departm Use Only)
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, orAgency
(if a person, must list agency/department representing) Northwest Motor Escort
Address 1915 KiblerAvenue
City Enumclaw State WA Zip 98022-3311
Phone (253) 653-0380 E-mail northwestmotorescort@gmail.com
Vehicle lnformation: List all vehicles being used as authorized emergency vehicles. For each vehicle,
provide both the vehicle and emergency equipment information as outlined below. Any new vehicles-or
vehicles with equipment installed other than what is authorized on the current permit for that vehicle-must
receive prior approval before being utilized under this permit.
VEHICLE INFORMATION
1
YEAR
2010
LICENSE NO
E598781
MAKE
Harley
Davidson
MODEL
FLHTPI
VIN
1HD1FMM149Y633921
REGISTERED OWNER
Thomas Chiswell
VEHICLE INFORMATION
2.
YEAR
2011
LICENSE NO
GA 8076
MAKE
Harley
Davidson
MODEL
FLHR-PI
VIN
1HD1FHM12A8614315
REGISTERED OWNER
Don Huiatt
1
FORMATIONEQINUIPMENT
INST MODEL
SIREN Whelen SD 210 R
LAMP COLOR(S)
LAMP MAKE/MODEL TIR6&TIR3
Red
Whelen
OTHER EQUIPMENT
EMERGENCY EQUIPMENT INFO RMATION
MODELMAKEINSTALLED
SIREN Whelen sD 210R
TIR6&TIR3
Red
Whelen
LAMP COLOR(S)
LAMP MA
OTHER EQUIPMENT:
3000-323-006 (R 12109)Page 'l of 5
VEHICLE INFORMATION
3
YEAR
2011
LICENSE NO
284578
MAKE
Harley
Davidson
MODEL
FLHP
VIN
1HD1FM1O886062 32
REGI STERED OWNER
Don Huiatt
AUTHORIZED EMERGENCYVEHICLE PERMIT
APPLICATION RENEWAL
EEM_W
VEHICLE INFORMA TION
6
YEAR
1 989
LICENSE NO.
831877
MAKE
Kawasaki
MODEL
K21000
VIN
3JKAKZCP22KB506647
REGISTERED OWNER
Kenneth Nish
N.ote: T.his page may be copied if additional vehicles need to be added to the permit. Any additional sheetsattached must provide the vehicle and equipment information in the same format as above.
ERGENCY EQUIPMENT INFORMATIONEM
DINS MAKE MODEL
SIREN Whelen SA
6&TtR3
Red
nLAMP MA KE/MODEL
LAMP COLOR(S)
OTHER EQUIPMENT
YEAR
1 999
LICENSE NO.
137255
MAKE
BMW
MODEL
RTP
w810418A1X2C651 49
VIN
REGISTERED OWNER
Thomas Chiswell
MODELMAKE
MERGENCY E QUIPMENT INF ORMATION
INSTALLED
SIREN Code 3 3672
LAMP COLOR(S)
LAMP MAKE/MODEL TIR 6
Red
Whelen
RedA/Vhite LED Liqht
OTHER EQUIPMENT:
ENCY EQUIPMENT INFORMATIONEMERG
INSTALLED MODEL
SIREN Whelen SD 2,10R
TIR 6
LAMP COLOR(S)
LAMP ODEL
Red
Whelen
OTHER EQUIPMENT:
YEAR
2011
LICENSE NO
LEM 9696
MAKE
Harley
Davidson
MODEL
FLHTPI
1HD1FMM12B8615992
VIN
STERED OWNER
Thomas Chiswell
REGI
EMERGENCY EQUIPMENT INFORMATION
ALLED MAKE MODEL
SIREN SA 450
TIR 6
LAMP COLOR(S)
LAMP MAK DEL
White/Red
len
OTHER EQUIPMENT:
3000-323-006 (R 12109)
Page 2 of 6
AUTHORIZED EMERGENCY VEHICLE PERMIT
APPLICATION RENEWAL
H,RgMWtr
2. Purpose of Application: Describe the specific purpose for which the vehicle(s) shall be used as
authorized emergency vehicle(s) and what necessitates the vehicles' registration as emergency vehicles.
Explain the nature and scope of the duties, responsibility, and intended use of emergency equipment.
Funeral Escorts Only
3. Authority: Explain authority outlined under statute (Revised Code of Washington) that allows the vehicles'
operators to use emergency equipment for the purpose outlined under part 2 of this application.
Chapter 204-36 WAC
RCW 46.37.190
RCW 46.37.194
4. Geographic Area: Check which types of roads you will be operating on and state the specific geographic
area(s) in which the vehicles shall be used as authorized emergency vehicles (city, county, etc.).
(Certification from each primary jurisdiction is required under part 7 of this application.)
X City Streets (list all cities)
Kent and Sumner
Bellevue, Buckley, Enumclaw,FederalWav, Lakewood,
X County Roads (list all counties)Snohomish
X State Routes/lnterstates l-5 (SeaTac area only) l-90 (Seattle-Bellevue area !n!y)
l-405, SR 18 and 99 (King, Pierce, Thurston and Snohomish counties only)
State Routes 164, 167 , 169, 509, 518,and 410 (Pierce and Kinq counties only)
5. Operators: Please list all drivers that you intend to have operating the vehicle(s) listed in this application
and indicate whether or not the operator/driver is new since your last application.
(Use additional sheet if necessary)
OPERATOR/DRIVER NEW OPERATOR/DRIVER NEW OPERATORYDRIVER NEW
Thomas Chiswell nr
tr
X
X
x
tr
Forrest Don Huiatt
James McCall
Kenneth Nish
Robert Crane
Earl Radford
n
tr
tr
tr
tr
n
n
3000-323-006 (R 12109)Page 3 of 6
AUTHORIZED EMERGENCY VEHICLE PERMIT
APPLICATION RENEWAL
6. Permit Validation:
I certify that:
a- All of the information given.in this app-lication js correct to the best of my knowledge and provided inits full format to the undersjOned chief law enforcement officer or fire chief (if the vehicle is to be usedfor firefighting purposes) 9! eagh primary jurisdiction in which the vehicles ire to be used asauthorized emergency vehicle(s).
b' None of the drivers, to the best of my knowledge in the last year, have been convicted oi nor,servedany sentences or periods of probation fo.r any felonies, nor irresied and convicted of a diug or'alcoholviolation orillegal use or possession- of drugs, nor been required to register as a sex offendlr, norhave any of them been adjudicated incomp-etent or insane.
c. Only the vehicle(s) and equipment listed. in this application will be used as ougined in this application,and that only the operators listed under this perniii witt drive tfre veniifllg, -
As the Pflary holder or executive officer in charge of overseeing this permit, I understand that if the permit isissued, it is my responsibility to ensure:
a- No driver listed in th.is permituses the vehicle for private purposes unless all emergency equipmeht isremoved orcovered. --.-r -r-'r"--'
b. No driver other than those listed u.nder this approved permit operates the vehicle(s) listed unless allemergency equipment is removed or covered. lf I wish to add a new driver or vehi6te to it'li pJrmit, I. must receive prior approval before they are authorized under this permit.
c. The driver rnust 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 civilliability as well as cancelldtion of this permit as outlined unOer cnipteizoa-go WAC:
ln.addition, I understand that it is.my.responsibility. to ensure that a copy of this permit and list of approveddrivers are present in each vehicle it alliimes ani must be presented tb law eniorcement, if requeiiieo.
- -
Signature t Title
i \ (cHlEF EXECUTTVE OFFTCER) _*-Name t:ttt;U-:8 t-- ! \\a<'sx-r-,erS -{
crYPE OR PRTNT)
7. Certification: This.renevral ap-plication for Author,ized Emergency Ve..hicie permits will not be accepteciunless CERTIFIED Qv t1e chief law enforeefient officer or fir6 cni'er.6 tne venicie is to be used forfirefighting purposes) of each primary jurisdiction in which the vehictis are to Oe uslJas-auJnorii"oemergency vehicles (see part 4 of this application). lf the application is made by tne cfriei oi J i"* -
enforcement agency or.fir.e department, it must uei cenrtriED by tne neio ot ifle poriii"ai iuo-oiui"ion. Thecertification must contain the following language:
"l hereby qq*jfy that I have reviewed this entire application; that I am aware that the applicant intends to
l=1,"-u-"lj9l9i|l."no'tmergency.equipment listed as specifically described in part z dttnis apptication; thata lgqd continues to exist.in my.jurisdiction for the listed vehicles io be used as iithorizeo emeiOency '
vehicles and that the applicanf has the.approlriate authority as describeO in p"rt g of tnis appfiC;t6;'t"operate such equipment; and I knov'r of rio reison why this'application shoutO Ue OenieOj'-""--'-" '-
Please type or print
Date
Signature Date
Jurisdiction'
E-Mail
Name '
(Please Print)
Phone
'Restrictions
3000-323-006 (R 12:/09)
Title
Page 4 of 5
AUTHORIZED EMERGENCY VEHICLE PERMTT
APPLICATION RENEWAL
H,R,qMWtr
7 certification: This renewal ap_plication for Authorized Emergency Vehicle permits will not be acceptedunless CERTIFIED by the chief law enforcement officer or fir6 chi'ef (if the vehicle is to be used for '
firefighting purposes) of each primary jurisdiction in which the vehiclis are to be used as authprized: :, ,.. ; ;emergency vehicles (see part 4 of this application). lf the application is made by the chief of a law
enforcement agency 9r,fir9 deparlment, it must Oe Cf nftfiED by the, head of the political: iub-division. Thecertificationmustcontainthefbllowinglanguage: : '' '. . . . ,
"l hereby
",94ity that I have reviewed this entire application; that I am aware that the applicant intends to
use the vehicle(s) and emergency equipment listed as specifically described in part Z df tnis application; thata need continues to exist.in my jurisdiction for the listed vehicles io be used as iuthorized embigencyvehicles and thatthe applicani has the appropriate authority as described in part 3 of this appticitioniooperate such equipment; and I know of no reason why this application shoulil be denied." ' '
Signature
Name
(Please Print)
Phone 61
Restrictions NdNF
Date 3 3i *ti Title fk,oof
Jurisdiction
E-Mail Jq -ft.r f-f 6F
..5.C{J
tfi
Signature
Name
(Please Print)
Date
Jurisdiction
E-Mail
Title
Phone (
Restrictions
Signature
Name
(Please Print)., , " Jtjiisdiction, ,: .,-, ,r ..j ::, , I
Phone ,, (, )
Restrictions
Signature Date
Jurisdiction
E-Mail
Title
Name
(Pleass Print)
Phone
Restrictions
Signature Date
Jurisdiction
E-tvtait
Title
Name
(Please Print)
Phone ( )
Restrictions
Signature
Name
(Please Prinl)
Date
Jurisdiction
E.Maii
Title
Phone ( )
Restrictions
Signature
Name .
Date Title
i.,.-
(Please Print)JurisdictionPhone (E-Mail
Restrictions
lf additional certifications are needed, add an additional sheet.)
3000-323-006 (R 12109)Page 5 of 5
AUTHORIZED EMERGENCY VEHICLE PERMIT
APPLICATION RE NEWAL
Date Title
(2 Jurisdiction
E-Mail
Date Tifle
Jurisdiction
E-Mail
Date
;ElMail
Date Title
Jurisdiction
E-Mail
Title
Jurisdiction
E-Mail
EE L_W
7 ' Gertification: This.renewal application for Authorized Emergency vehicle permits will not be acceotedligffi,fiE}I',Ffto ot tne cnitiiriw ;;r".;d;;i;rri;;i"iii; cni6riir ine ueil;[], to be used
emersency u"nirtrlttlroJu";:lT'#?floiurisdiction in ;hij'tiie ,vehicris ;i" i; ;;;ed as guthorized :,
::F,1,::nr#J*'J"t#f 3;s,ffi i|ffi :;y.[$':FPJiX'i#igx'&?iliF"',ffi i3iillitl;,.rs'vuqY9.
Sign
Nam
(Please Print)
Phone
R-estrict
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The
that
L/ C ,€*_
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Signature
Name
(Please print)
Phone
Restricti
!ons
ons
S!gnatureName' :
Restri ctions
Signature
Phone
(Please print)
Name
(Please print)
Phone
Phone
Restricti
Restrictio
Signature
Name
(Please print)
ns
ons
Signature
Name
(Please print)
Phone
Restricti ons
Date Title
Jurisdiction
E:Mail
Date ,.--
JurisdiCtion
E-Mail
additional certifications are needed, add an additionar sheet.)
Signature
Name
(Please print)
Title
Phone (
Rest rictions
3000-323-006 (R 12109)
)
tf
Page 5 of5
AUTHORIZED EMERGENCY VEHICLE PERMIT
APPLICATION RENEWAL
mmEt-EisIiidifiTiliEFliFdlWtr
6. Permit Validation:
l certify that:
a. All of the information:given in this application is correct to the best.of my knorMedge and provided in
its full format to if.re uidersigned cfridt taw 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 senteni.r oipbiiooJof probation for any ielonies, nor drrested and convicted of a_drug or alcohol
vio-lation or illegal use or. possession of drugi, nor been required to register as a sex offender, nor
have any of th6m been abjudicated incompetent or insane'
c. Only the vehicle(s) and equipment listed in this application will be used as outlined in this application,
and that only the dperatorb listed under tfris 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 private purposes 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 covereil.' lf I wish to add'a new driver or vehicle to this permit, I
mustieceive iribr 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^Y"h1"1"9 may result in criminal or civil
ii"nlf ity is weff as cancelidtion of this permit as outlined under chapter 204-36 WAC.
ln addition, I understand that it is my responsibility to ensure that a co.p.y of this permit and list of approved
oriveit are present in'eicn vehicle it all'times an'd must be presented to law enforcement, if requested.
Signature \l' Q v'*--"=-*-u (:Title L{:\..(}
(CHIEF EXECUTIVE OFFICER)
Name I;l 6,-kr\ s--\ <' t- Utg,t"*{ r" L Date '**\..q"-T:rl
7
(TYPE OR PRINT)
certification: Th6 renewal application for Authorized EmergenQy Vehicle Permits will not be accepted
unless cERTtFtED uV tiJ lni.it tu* enforcement officer or fire chief.(if the vehicle is to be used for
tii"nghti"g puipoJesl'oi eacn primary jurisdiction in which the vehicles are to be used as authorized
"m"ig"niy'vehictes i.ee F"rt t of thls applicatlgn).^tl!!p.a,pj{cation is made_by the chief of 3 llvt1
enfor[emdnt agency'oitirb oepart.ent, jtmust nei crnrtriED by the head of the political sub-division. The
certification must contain the following language:
,,1 hereby certifv that I have reviewed this entire application;.that I am aware that the ap-plicant intends to..
use thJ'veflffisl ano emergency equipment tist# as specifically described in qa$ 2-of this application; that
; *u;"""tinudito &irt in hy;Jrisciiciion for the tisted vehicles to be used as authorized emergency
uenict"" and that the applicanf has the.appropriate authority as described in part 3. of .this application to
"p"i"t" *"f.t Jquipmefii; anO t t<now of rid reison why this-application should be denied."
Please type or print:
Signature
hlamat lacu I trt
(Please Print)
Phone
Restrictions
Date
Jurisdiction
d I ritra
3000-323-006 (R 12lO9)
E-Mai
I 0 ultt{ OF
Page 4 of 5
AUTHORIZED EMERGENCY VEHICLE PERMIT lll tlj lrrrrE\
wlsr{Nclolt stATE PATRoTW'.APPLICATION RENEWAL4
6.PermitValidation: :: .. .r-
. ... . . .: : l ,. , .,'. n ,'l ' ..,
lceftifytha[;1i. , '.,t:...]..:jj r';'. '..'.;.. .:;1.',' :':'-, ...r ' ....;.. 1,'r'.t.t. .,..''':
a. All of the informatjbnjgiven in thi6 appiication is coiiect to the best of
its f_ull lgrrqt to the uidersign-d chi€;r raw enforcer"nt omcEr-JrJi[
ror.trrefrghting purposes)of each primary jurisdiction in which the v_ehauthorized emergency vehicle(s).
b. None of the driveqs; to the best of my knowledge in the last year, have been convicted of, nor servedany sentenc_gs ol periods of probation for any feJonies, nor irresied and convicteo of I oiuo oi.inonotviolation orillegal use or possession of drugd, nbr beeh requiieo to r-gist"r;.-; {ei "ffE;;!;';thave any of them been adjudicated incomp-etent or insane"'
c. Only the vehicle(s) andcquipment lisled..in this application will be used as ouflined in this application,and that only the operators listed under this perniitwill dr,ive the vehicle(s).. #f ,fi.{ : +.j,,
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 ens;ure:
my knowledge and'
chief (if the vehicle
icles are to be used as
a' No driver listed in this permit uses the vehicle for private purposes unless all emergency equipment isremoved or covered.
b' No driver other than those listed under this approved permit operates the vehicle(s) listed unless allemergency equipment is remove-d or covered.' lf I wish to add a new driver or vehiile to inli permii Imust 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 inapqlopriate oi misuse of authorized emergency,vehicles may resultliability as well as cancetidtion of this p"rmii ;; "guilqdffiei inapter 204-36 wAc.
in criminal oi civil
. ... ...r.,,--.-.- ",'', rl
Signature
Name
-[-" 0 r\' \ VLi.-,
(cHrEF oFFrcER)
Title
Date\*'6-rv\q\![,i (t.ii.t(,
7
Please type or print:
Sighatufd
l'Jame
(Plea.s€ Print)
Phbne
s ei€-
- t;5
,{tu"s
(rv.!Ji oR PRtNr)
Certification: This renewal ap-plication for Authorized Emergency'Vehicie permits will not be acceptedunless cERTlF|ED Qv ihe chidf law enforcement officer oi iir"e
"nii,r tir ih; ;hi;i;'is to be used forfirefighting pirrposesl oieach primary juriscictio; i; irfiiet;tne vehictj*re to ne usLJJr *.'i[Jriiioernei'genci/ 've!'licles (see part 4 of thiS app.licatiln). lf the application is made by the chief of a taw
:llo,I99tr"IFg",1tv.or.fir.g departmenl i-t'lrlust uej cEnrtriro o/ tt''e neil or tfiu p"riti""i iun-iivision. rnecenrtlcatton must contain the following language:
"l hereby c,e,4ify that I have reviewed this entire application; that I am aware that the applicant intends touse the vehicle(s) and gT.ergency.equipment listed as specifically described in part z <if tnig,appriiition; tnata need continues to exist in my jdrisciiction for: the listed vehicles io be used as iuthorized emlioen;; '
vehicles and that the applicanf 6as the.appropriate authority as describeO in plrt S'Oi ihid
"i;i'td;tior tooperate such equipment;and l know of rid rebson why this'application should be denied.T
Date
lil
ilylAilriuB:
Jurisdiction '{'
:. ':.'1;: j;,.r,..;,;....!
li: :i.', l.;'t ' ; 11
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Page 4 of 5
AUTHORIZED EMERGENCY VEHICLE PERMIT
APPLICATION RENEWAL
H,F-HMWT
7
Signature
Name
(Please Print)
Phone
Certification: This renewal ap-plication for Authorized Emergency Vehicle Permits will not be hcceptedunless CERTIFIED by the chiet law enforcement officer or fire chiAf (if the vehicle is to be used for '
firefighting purposes) of each primary jurisdiction in which the vehiclds are to be used as authorized, , , .:
;emergency vehicles (see part 4 of this application). lf the application is made by the chief of a lawenforcement agency orrfire deparlment, it must be CERTIFIED by the. head of the political sub-division. Thecertification must contain the fbllowing language:
2-
?h"l rr Title Fcx-.rc-6; C--$.-f L1TS
applica
of this
that the nt intends to
in part 2 application; that
as authorized emergency
part 3 of this application to
d be denied."
e-\
Restrictions
Signature
Date
Jurisdiction
E-Mail
Date
Jurisdiction
E-Mail
Title
Name
(Please Print)
Phone ( )
Restrictions
Signature
Name' ' ''
(Please Print)
Date
,E-MailPhone ,.(, )
Restrictions ,
Signature Date
Jurisdiction
E-Mail
Title
Name
(Please Print)Phone ( )
Restrictions
Signature Date Title_'-_Narne
{Piease Pr!nt}
Phone
Juriseliction
E-Mail
Restrictions
Signature
Name
(Please Print)
Date
Jurisdiction
ErMail
Title
Phone ( )
Restrictions
Signature
Name
Date
E-Mail
Title
(Please Print)
Phone
Jurisdiction
Restrictions
lf additional cerlifications are needed, add an additionalsheet.)
3000-323-006 (R 12l0e)Page 5 of 5
AUTHORIZED EMERGENCY VEHICLE PERMIT
APPLIcAloN RENEWALJi
H,RHMWtr
6. Peimit Validation:
I certiff'that'-'.."' ' ',,,'.1,.:. ii:
: : ... : i ' : l1r::
nowledge and prwiOed in
(if the vehicle isto be used
are to be used as
a c-opy.of this.permit and list 6t appr.wed '' '
nted to law enforcement, if requested;. , . ,
b. None of the drive[S; to the best of my knowledge in the laSt year, have been cbnvicted of, nor served
any sentences or periods of probation for any feJonies, nor arrested and conviited of a_drug or.alcohol
violation or illegal use or possession of drugs, n6r b'een.required to register as a Sei off6nd-er, nor
havg:any of them been adjudicated incompetent or insane.
c. 04ly 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).
. r''€* :JilI i.ri.r
it tttg piintary holcjer or executive officer iri charge of overseeing this pernnit, I understand that if the permit is
lssuecl, it is my responsibility to ensure:::
' a. No driver listed in th.is permit uses the vehicle for private purposes unless all emerge.pcy equip;nent 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 vel.r[cle, 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.
All of the informatibn given:in thiS appiiCatiori is correct to ftre best of my k
its full formqt to the undersigned chief law enforcement officer or fire chlef
for firefightiiig pur:poses) of each primary jurisdiction in which the vphicles
authorized ernergency vehicle(s);
ln.addition, I u_nder.stqnd that it is my responsibitity to elniuie,fnat
drivers ale present in each vehicle at all times and must b9 prese
I understand that the"inappropriate or misuse of-authorized emergency-vehicles may result in criminal or civil
liability as well as cancelidtion of this permit as outlined.under chipter'204-36 WAC: ,, '
.t .-............
Signature
Name
TLr'*
(cHrEF EXECUTTVE OFFTCER)n
\tf .t )1-\dl, <) S-.i.i.l*:\ C*(-L
Title
Date
q=\ _L-\ -?o\ \.
(TYPF OR PR|NT)
7 Certification: This renewal application for Authorized Emergency Vehicle Permits will not be accepted
ttnless CERTIFIED by the chief law enforcement officer or fire chi-ef (if the vehicle is to be used for
firefighting pi.rrposes)'of each primary jurisdiition in wnipn the venictesare to be useci as-auihorizerJ
emergency vehicles (see part 4 of this applioation). lf the application is made by the chief of a law
enforcpment agency or fire department, il]must be CERTIF[fO Uy the head of the political sub-division. The
certification must contain the following language:
u
hereby certifv
se the vehicle(s
applicant intends to
of this application;
rized'emergency
this ajiplication to
that I have reviewed this entire application; that I am aware that the
) and emergency equipment listed as specifically described in part 2
tq exist
the app
in my jurisdiction for: the listed vehicles to be used as autho
that
a need cohtin ues
vehicles and that has the appropriate authority as deScribed in
operate such equ d l-know of no reason why this application shou
Pledse type or
pbrt 3 of
ld be den ied.'r
, \.'.
SigndtuFe
Name
(PleaF€ Print)
Pht6ne
Restrictions
"Date
Jurisdictio
Titlp
3000-323-006 (R 12/09)
E-Mail
Page 4 of 5 :jr
AUTHORIZED EMERGENCY VEHIG LE PERMIT
APPLICATION RENEWAL
H,F-HffiWtr
7 Gertification: This renewal application for Authorized Emergency Vehicle Permits 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 vehicles are to be used as authorized, ,' .. : :
emergency vehicles (see part 4 of this application). lf the application is made by the chief of a law
enforcement agency or fire deparlment, it must be CERTIFIED by the. head of the political sub.division. The
certification must contain the following language: l
"l hereby certifv that I have reviewed this entire application; that I am aware that the applicant intends to
use the vehicle(s)and emergency equipment listed as specifically described in part 2 of this application; that
a need continues to exist in my jurisdiction for the listed vehicles to be used as authorized emergency
licant has the appropriate authority as described in part 3 of this application to
and I know of no reason why this application should be denied."
vehicles and that the a
operate such
Signature
Narne
(Please Print)
Phone
Restrictions
oarc /fty'r riue
Jurisdiction Orr/
O t,; /-€ 2,,, d
oF ,f.,
E-Mail er,cJa .u
Signature Date
Jurisdiction
E-Mail
Title
Name
(Please Print)
Phone ( )
Restrictions
Signature
Name' r"
(Please Print)
Phone ,,(, ).
Restrictions
A
'
j
''l;" '
Signature Date
Jurisdiction
E-Mail
Title
Name
(Please Prinl)
Phone ( )
Restrictions
Signature Date
Jurisdiction
E-Mail
Title
Name
(Please Print)
Phone ( )
Restrictions
Signature Date
Jurisdiction
E.Mail
Title
Name
(Please Print)
Phone ( )
Restrictions
Signature
Name
(Please Print)
Date
i..
E-Mail
Title
Jurisdiction
Phone ( ,)
Restrictions
lf additional certifications are needed, add an additional sheet.)
3000-323-006 (R 12109)Page 5 of 5
AUTHORIZED EMERGENCY VEHICTE PERMIT
APPLICATION REN
I understand that the inappropr,iate or misuse of.authorizedliability as well as cancellation of this permit as ouflin
&
PefmitValidatiOn:.': ;:r':.1.;''' :, *-: . . . :.!.... . :., .....,.....
:. . .,. ,,:.'i,'i: . . . t.. . : ..'t ..... ...;1.:.:lcertifythat: '..' i.':.r:,;i. '..-. .:' ,.i ,,: t,:.;.,$ ,, i: .,...: .. i ; ., .,..i; . . ...:,:. . ,. : .'..., .;:.: . ,:...r,
:a' All of thd infoimatibn.glven in this app-iication js iorrect to the bebt of my t<nowteoge and provided in
if-lYllgrut to the undersisned .hiut ii* "nr-."r!-ri "nicer
or fire chief (if th;v;;t':,!'ia"'iJil:oror rlretlghtlfig pu.rposes) 9{ qagn primary jurisdiction in which Jhe yBhicles ire to be used asauthorized ernergency veh icle(s).
b' None of the driver;s; to the best of my knowledge in the last year, have been convicted of. nor served'any sentenees or periods of probation for any flJonies, nor drresied and #ui;i;;i]Jiuq or.ar"onorviolation orillegal use or pos'sessio.n of drugi, ndr uJbi."req;iia;'t" ;g[t"r ;;9"#"fi[;;H'r;,have any of them been adjudicated incomp-etent or insane.'
c' only the
":Jtj:j:_ftl_119.:q"ipT".nt lis.ted..in this application will be used as ouuined in this apptication,and that only the operatbrs listed under tnis perniiiwitl aEive the ";i;1"(").
S: thq Pllnary holder or executive officer in charge or oriis..inn'"[,'n oii;1, I unoerstand that if the permit isissued, it is my i-esponsiliility to ensure:
a' No driver I:P-d il ih,it permit uses the vehicle for private purposes unless all emergqncy equipment isremoved or covered.
b' No driver other than those listed u.nder this approved permit operates the vehicle(s) listed unless allemergency equipment is removed or coveredl. tf I wjs'h to add a new driver or vehii,le-io inls peimit, Imust receive prior approval before they are authorized undei 1-ris permii. ,
c' The driver must exercise due care and caution and must obey all traffic taws.
'| ,t
-
ln addition, I u_ndersta
drivers are present in:
tr',-
nd that it is.my. re.sponsibility to ensuretihat a copy of this permit andeach vehicle at all times and must be presentea tli law enrorcem.ni,; " ' ' -' --- ::- ^-
T Q\.*.-.u*e-Q-. (Title ?..o,--Ao- -t
Iistii-f apprwed :1r :,
if_rggyested; . , '::'
Signature
Name
(cHrEF
I Date \-q - 1;: i I
.f.
crYPF oR PRTNT)
7 Gertification: This,renewal application for Authorized Emergency Vehicle permits will not be acceptedunless'CERTIFIED by t-he chi6f law enforcement otriceftinr-e cni6rlit:tne veni"ie is to be used for' lirefiOhting p'urpcses) cf dach primary jurisdidtio;i in *nien'tiiu vehicles&re ts be useci as aurhorized " . '
:ll9!99ncv vehicles (see part 4 of thisapplication). tf the apptiCation iJmlo" bylh;;h[i;iiii;-enTorcement agency 9r.fire department, Lt*must be CERTIFiED by the head of the potitiiiltun-oiJision. rnecertification must cdntain the fbllowing t'affiuage: - - '- --- -t -;'. "--- -' "'Y '
"l hereby c$4ifY that I have reviewed this entire application; that I am aware that the applicant intends touse the vehicle(s) and emergency.equipment list# Ji speJinCairv aes6;il ffii;t 2 of this apptication; thata need continues to exist in my jdrisdiciion for the tisteoiieniites to be used as iutno-rii;;r5[;;"'vehicles and that the applicanf has the.appropriate iJtnoritvii o"=sciioeJiiE,r 3;'ih;";1,p#ti";i"operate such equipment;"and l"knowof rio rehson why'tniJ'appticatipn snouto ne denied,'f -. -
Please type or
SignatUie -
l'Jame
(Plea;;-g Print)
Pht6'ne
Restii ctions
:"': t' 1 ,'
i,- " . .' t,, . ,; ,; .," j. .
:.,
-... .:,..',-;"4.\' ,-. : . ':-'' Date
Jurisdiction
E-Mail
3000-323-006 (R 12lO9)
I *q
Tiile
iil nn r ln trTY
Page 4 of 5
AUTHORIZED EMERGENCY VEHIC LE PERMIT
APPLICATION RENEWAL
H,F"HMWtr
Gertification: This renewal application for Authorized Emergency Vehicle Permits 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 vehicles are to be used as authorized .
emeigendy'veiricles jsee part 4 of this application). lf 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 contain the following language
"l hereby certifv that I have reviewed this entire application; that I am aware that the applicant intends to
use the venicteG) and emergency equipment listed as specifically described in part 2 of this application; that
a need continues to exist in my jurisdiction for the listed vehicles to be used as authorized emergency
vehicles and that the applicant has the appropriate authority as described in part 3 of this application to
operate such equipment; and I know of no reason why this application should be denied."
Signature Date H-V*tt Tire C6prF,1*1
7
Name
(Please Print)
Phone
Jurisdiction L.
E-Mail S?e.ve. tRtt,?^,t/ s 4z)\"\/s'F" i"tA" Cud
Restrictions i?E*-nt r-T&D .f(?tfJTEN*g rET-eS /rJ ,r D SnqfE t?utlTFS l*, Kt rJu CcruiliY,
ft,l€ B-)S r*TE feszrev. *:4
Signature Date
Jurisdiction
E-Mail
Title
Name
(Please Print)
Phone ( )
Restrictions
Signature Date
Jurisdiction
E-Mail
Title
Name
(Please Print)
Phone ( )
Restrictions
Signature Date
Jurisdiction
E-Mail
Title
Name
(Please Print)
Phone ( )
Restrictions
Signature
Name ,
(Please Print)
Date
Jurisdiction
E-Mail
Title
Phone ( )
Restrictions
Signature Date
Jurisdiction
E-Mail
Title
Name
(Please Print)
Phone ( )
Restrictions
Signature
Name
(Please Print)
Date
lr rrior{intinngst tgvlvltvt I
E-Mail
Title
Phone ( )
Restrictions
lf additional certifications are needed, add an additional sheet.)
3000-323-006 (R 12i09)Page 5 of 5
AUTHORIZED EMERGENCY VEHICL-E PERMIT
APPLICATION REN :ns*
o
6. Peimit Validation:'. I:... ": : {...'It, :
... ,.. :, .: , .1..,..:.,' . ,.. ,,-, . ." a. ' All of the informatibnjgiven.in thiS'?ppiiCatiori is correct to the best ot my knowtedse.and' piovidbd inits full forrnqt to the undersigned chidt taw enforcement officer or fire cfrlet (if 'tn! rianicf" i! to Uu-ri"Ofor.firefightiiig purposes) of bach primary jurisdiction in which lhe yehiclei ire to be used asauthorized ernergency veh icle(s).
b. None of the driveqs, to the best of my knowledge in the ladt year, have been convicted of, nor servedany sentences or periods of probation for any felonies, nor drrested and conVicted of a diuq or.alcoholviolation orillegal use or possession of drugd, ndr been required tci register as a $ef ofrEnoLr, norhave any of lhem been adjudicated incomp-etent or insane.'
c- Only the vehicle(s) and.equipment lisled in this application will be used as outlined in this application,and that only the operators listed under this perniitwill dJive the vehicle(s).! ' 4t r.{l tti'r
ff.ft q|f ?y !911", or executive officer in charge of overseeing this permit, i understand that if the permit isrssued, it is nry. responsibility io ensuril:
' ". No driver listed in th.is permit uses the vehicle for private purposes unless all emergency equip;nent isremoved or covered
b. No driver other than those listed u.nder this approved permit operates the vehicle(s) listed unless allemergency equipment is removed or coveredJ.' lf lwis'h to add a new driver or veniite to this permit, Imust receive prior approval befoie they are authorizbd under this permit.
c- The driver must exercise due care and caution and must obey all traffic laws.
I understand that the inappropr,iate o
liability as well as cancelidtion of this
r misuse of authorized emergency vehicles may result in criminalor
permit as outlinefl und-er chipteizOq-ZA WAC:
civil
,. j : .: r,
't.1 :l.. .:
ln.addilion, I undqrstand that it is my.re_sp.o.1rs[[ilitir to ensuie,tnat a capy of this.per:m.it and list bf appr.oved ',': .;
drivers are present in each vehicle it atliimes anii must be presenteoto law Jniorcemeni,liiulfiji.i, t.. ., r,r. ,. ..._.--., 1..'._ -f :_. ---.''
Signature T,Title
(cHtEF EXECUTTVE OFFICER)
+fi" r\vut.cs}"r1$.g t t\i.{J>-r.tL\.Date t-l-' . tt - ?= t t
crY:jE. oR PRtNr)
Name
7 Gertification: This.renewal ap_plication for Authorized Emergency Vehicle permits will not be acceptedunless CERTIFIED fV tne chiellaw enforcement officer or fir:e chi'ef (if the vehicle is to be used for '
'firefighting purposes)-of each prirnaqy juriscliGJion in which the vehicles€re to be used as authorizedemergency vehicles (see part 4 of thisapp.lication). lf the application is made by the chief ot a lavrenfolcement agency glfil? departmenl ij-must uei cfnrtriED by the head of ilie potitiCat suu-division. tnecertification must contain the fbllowing lai$uage:
"l hereby c,e=4ify that I have reviewed this entire application; that I am aware that the applicant intends touse the vehicle(s) and emergency equipment liste'd'as ipeiificatly desiribed in part z <it tnis appficition; tnata need continues to exist in my jurisdiction for,the listed Vehicles io be used as iuthorized emiiqencv '
vehicles and that the applicanf has tne.appropii"ie -l1n"ritv
"" als"iiueo ii;;rt 3';l fiir #ilidtri'tooperate sulch equipment; and I know of rid rebson why this'applicati.on should be denied.r i i , ,1.,, ,,,, .
Pleasei type or
Signatufe
Name
(Plears..e Print)
Phbne
Restiictions
'Date
i i,r,Jurisdiction
?tA ksY-rta8 E-Mail
o OL)T4e6,a-5 a|--e
hS?.na tJ
br
4
300G323{06 (R 12/09)
ftr,.r-tzs,or; oia@'cF.oe a.NQ /6*e8- rqao
Page 4 of 5
f
hlvl*
AUTHORIZED EMERGENCY VEHICLE PERMIT
APPLICATION RENEWAL
H,F"HMWT
7
Signature
ave reviewed this enti
m ergency equipment
n my jurisdiction for
licant has the app
and I know of no
J*l -fi {t-
Gertification: This renewal application for Authorized Emergency Vehicle Permits 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 vehicles are to be used as authorized : .. ;
emergency vehicles (see part 4 of this application). lf the application is made by the chief of a law
enforcement agency or fire deparlment, it muqt be CERTIFIEQ by the head of the political subdivision. The
certification mqst contain the following language: :
"l hereby certifv that I h
use the vehicle(s)and e
a need continues to
vehicles and
operate
Signature
Name
(Please Priot)
Phone ?,
Restrictions
re application; that I
listed as specifically
the listed vehicles to be used
). Jurisdiction
E-Mail
am aware that the applicant intends to
described in part 2 of this application; that
as authorized emergency
part 3 of this application to
ld be denied."
l-\
L 4-AM
Date
Jurisdiction
E-Mail
Title
Name
(Please Print)
Phone ( )
Restrictions
Signature
Name
Phone ,,, (. )
Dat9, -'---- Tjtfe
.''' ;."..., : JUiiSdiCtioii,.,.., '; .. :,'.. i
Mail
t
Li
!,(Please Prht)
Restrictions
Signature Date
Jurisdiction
E-Mail
Title
Name
(Please Print)
Phone
Restrictions
Signature Date
Jurisdiction
E-Mail
Title
Lt-- -tYdllic
(Please Print)
Phone ( )
Restrictions
Signature Date
Jurisdiction
E.Mail
Title
Name
(Please Prinl)
Phone
Restrictions
Signature Date Title,-.-
l .;ii: .
JurisdictionName
(Please Print)
Phone ( , )' E-Mail
Restrictions
lf additional certifications are needed, add an additional sheet,)
3000-323-006 (R 1Z0e)Page 5 of 5
AUTHORIZED EMERGENCY VEHICLE PERMIT
ORIGINAL APPLICATION
mnEr--..Fis-mci6TtiifiEiffiWtr
7 Certification: This renewal application forAuthorized EmergencyVefricle Permits will not be accepted
untesi SERTIFIED nv tnJ inier ra", enforcement officer or fire chief (if the vehicle is to be used for
tir"nghting puipoiesl'oi eaCn primary jurisdiction in which the vehicles are to be used as authorized
iljddi vehictes i"p" p"rta oitnis. gpptlcation).^tJ the. apj-lication is madety the chief of a law . .
enforcement agency*'JinrE crp.nme-r,t, li ru"t uei cgnrLriED by. the,hpbdiofthe poJitioal s,-t;bdivisioh.. The
certification must coritain.,the following languaoe: ---T:"-i:""',']-;;-". .i. "--"*:i'",,-.jt.i... oi .'i ..:
"l hereby certifv that t have reviewed this entire aBilicqti.efr;.!ha! I qm aY,are. ll"tlql"pflicant intends to
.
use thJ ven-iretsl ano emergency equiprhent iiste'd es bpecificailf described i1 na(_!_or this application; that
i ne"o exists in' #ry jurisdicti-on for *rb tisted vehiclps to betsedis duthorizgd e{nergelclYei'tcJesand that
tnu "ppri"int
has th6 appropriatd authority as described ln piirt 3 of this"application to opetate such
equipriient; and I know'df nb reason wny inis aBplication should be denied.'
Please type or print:
Signature Date fi17'zqiTitte OF;mt- 'Asr{-tf Ct'rv@-
+'durisdictiqn.
il
?fr) l.Title
'f
4 i\,
Jurisd
E-Mail
Date Title
Jurisdiction
E-Mail
Date Title
Jurisdiction
E-Mail
Date Title
.,4j uJurisdibtion
E-Mail
Date Title
Jurisdiction
E-Mail
Date Title
Jurisdiction
E-Mail
'*.Fr
"4 ...: "
-
iSartre-
(Pleass Print)
Ph"bne
; Rettrict!
, -r-.{ +.. I i; l-'nl. i
ti"r,i,f , y c t!..,.a {.'i..,,t,r.'j, ;.rr lii;r-*|j J\
sigq?[H
Name
re. f+l -C,-J.y-&atL"e-L
J;J.--
. r i rl-.
ibtion '
.J
Phone ( )
Signature
(Please Print)
Name
(Pleaso Print)
Phone
Name
(Please Prht)
Name
(Plsas€ Print)
Phone
Name
(Ploas€ Print)
Phone
(Ploas€ Print)
Restrictions
()
Restrictions - ,
Signature
Phone ( )
Restrictions
Signature
Restrictions , , :: :.
Sigfiature
()
Restrictions : -
Signature
Name .i , ,.,-at; /
Phone ( )
3000€23{06 (R 1Zo9)Page 4 of 4
Restrictions ''
(!f additional certifications are needed, add an additional sheet')
r,
F''ife Police Department
James M. Paulson Criminal Justice Center
3737 Paciftc Highway E. Fife, Washington 98424-1135
Phone: {2531922-6633 I Fa-x (253) 922-t22O
May 10, 20L1
Mr. Tim Chiswell
Northwest Motor Escort
1915 Kibler Avenue
Enumclaw, WA 98002-331'1"
Mr. Chiswell,
This letter is to advise you that Northwest Motor Escorts does not have authorization to conduct any
business within the city limits of the City of Fife. This includes Pacific Highway East (Old 99) within the
city boundaries starting at the west city limits of the Puyallup River and the east city limits in the 6300
block.
Any violation of this will result in immediate enforcement action
Please contact this office if you should have any questions'
Sincerely,
B.ackbu rn
Chief of Police
cc: Chief James Arsanto, Buckley Police Dept.
Chief iames Collyer, Puyallup Police Dept.
Chief Bret Farrar, Lakewood Police Dept'
Chief John Galle, Sumner Police Deaprtment
Chief Don Ramsdell, Tacoma Police Dept.
Chief Brian Wilson, FederalWay Police Dept.
Chief Robert Lee, Auburn Police Dept.
Chief Linda Pillo, Bellevue Police Dept'
Chief Ken Thomas, Kent Police DePt'
Chief Jim Zoll, Enumclaw Police Dept'
Chief John Diaz, Seattle Police Dept.
Chief John Batiste, Washington State Patrol
Ms. Melissa Van Gorkom, Equipment & Standards
Sheriff Paul Pastor, Pierce Co. Sheriff's Office
Sheriff Steve Boyer, Kitsap Co' Sheriff's Office
Sheriff Will Reichardt, Skagit Co. Sheriffs 0ffice
Sheriff John Lovick, Snohomish Co' Sheriff's Office
Sheriff Sue Rahr, l(ing Co. Sheriff's Office
Captain Steve Burns, WSP District 2
Captain Jeff DeVere, WSP District 1
Captain Karen DeWitt, WSP District 6
Captain Ken Ginnard, WSP District 7
Captain Jeff Otis, WSP District 4
Captain Ronald Rupke, WSP District 5
Captain Steve Sutton, WSP District 8
"The frept.seryes the people of Fife by praviding law enforcement services in a prafessional and
caurteous manner,
'and
it is fo ihese peaple that the Dept. is ultimately respansible."
Ch!RI5T!NE CI. GREGOIRE
Governor
loHN R. SATISTE
Chief
STATE CIF WAShI!NCTON
WAS r-{ [ NCTC i"i STATE P/\TR{} L
Cenera! Aclministration Euilding ' PO Box 426sg ' Olyrrpia' wA 9s504-269$ " {360) 596-4080 6 www'w$p'wa'Bov
May 5,2011 R"E,9r€ LY'EP
MAY i.',,r ?'f'W,4
Mr. Tim Chiswell
Northwest Motor Escort
1915 KiblerAvenue
Enumclaw WA 98002-3311
Dear Mr. Chiswell:
The renewal application for the Authorized Emergency Vehicle Permit (AEVP) for the
vehicles used by Northwest Motor Escort has been received' However' this renewal
application cannot O" ptot"tted until.it is complete andall necessary paperwork has
O;"n prouided to the Washington State Patrol's (WSP) Equipment and Standards
Section.
Please make the amendments necessary to your renewal application and/or provide the
additional paperuvork as outlined in this letter'so that the \A/sP can process this renewal
application
1. Vehicle Information - your current AEVP only authorizes the following vehicles for
funeral escort services:o Licen." Esgaza 1 Qo10 Harley DavidsonfLHTPl), owned by Tim Chiswell
o Licenr" cAabz-o t)oro Harley Davidson FLH), owned ,o,v
D:n Huiatt
. t-icense iAiSlA 12Olt Harley Davidson FLHP), owned by Don Huiatt
we received copies of the certification of Emergency Equipment for the following
vehicles:o License 87255 (1999 BMW R1 1oORT), owned by Tim ch'swell
e Licen"" [enf gO'gO (ZOt 1 Hartey FLH1PI), owned by Tim Chiswell
r Licer;; StiBtt iie'Be fawasat<i KZ100d), owned by Kenneth Nishiyori
However in orOJitJ-proi"tb- tf'" nVfF jpplication f6r these vdhicles, you need to
llifjtiiin" oiiginat inspection paperwork. 'Once we receive this paperuvork we can
process your app-iicjtibn to ad'd ifrese vehicles to the permit.
ln addition, this office has not approved the following vehicles listed on your renewal
lpptiCiiion for operation under your current AEVP:
. LicenJ" fE1ngi6S (Hlrfe' Davidson FLH), owned by Pete-Noetezl
o Licen"" FFgsr05 (irartey Davidson FLH), owned by_Jim McCall
o Licent" SnZOg3 (Harleybavidson FLH), owned bV p9l.Cra19
,. Liceni" +AgASZ iHartey Davidson FLH), owned bY Mellissa lrish
,
Enclosed is a certificate of approval gra!!{19 a thirty-d.av period for these vehicles to
receive an equip"mii'rTi'r]rp'""fi5n-nvifiJWsF, atong witti i certiticate of Equipment.
please take this form to the nearest Wasfrinqion p-tite. Patrol office with the vehicle for
;ff;l"t,d. Atteiir," io rm is go_mpieieo] qqTt p.: was h i n_sto n s]ate?atrol,
Eqri-p-"nt anJ'SianOiias, pO liox 42600, Olympia WA 98504-2600'
ffiNT POLICE DEPARTfuIENT
&qp
Page2
Mr. Chiswell
May 5, 2011
All vehicle and equipment information needs to be outlined on the application. Pleaseadd the vehicles that were listed in your attachment to page two of fciur permit if you
intend to have them included on thd permit and include alivehicle inforniation
necessary
Please re-submit the application with all information filled out in the application andprovide !ft" "pP!"qpriate.papenruork
(originalCertificates of Emergency'Equipment), orremove the vehicles not authorized from your application as outli-ined'aOove so th6t wecan process it.
2. Purpose of Application & Authority - Your renewal application indicates that onepurpose of your application is that the company will assisi pilot vehicles transporting
oversize boats and houses and provide security and escort function for the Sbattle-
Seahawks team bus and equipment vehicle as-required.
Chapt.er 204-36 WAC outlines the rules regarding authorized emergency vehiclepermitting. Under WAC 204-36-040 (1Xe), a veh-icle ". . . being usd'd toi escort
services, may be used only for funeral escorts."
Pilot vehicles are not authorized under the process outlined in Chapter 204-36 WAC,
and are only allowed to use amber lighting'as outlined in WAC 204:-21-130.
Further, on one version of the documentation you provided it was indicated that "we
are.not pilot vehicles,.we only clear the intersection for the licensed pilot vehicles
working the oversized load."
Please note, thatrothing in your permit allows your company to "clear an intersection"
for any purpose. The only authority under statuie for this'funltion is outlined under
Revised Code of Washington (RCW) 46.61.035, which states "The,driver of an
authorized emerge,ncy vehicle, when responding to an emergency call or when in ,pursuit of an actual suspected violator of the law... may exeriise lrivileges set forth in
this section..."
Escorts are not considered an emergency, therefore authorization is not provided foryour company to operate under RCW 46.61.035 to provide any type esc6rt services,
including funeral escorts.
Please amend your permit application to rernove the additional piloting services
and/or provide the appropriate statutory authority that allows you to piovide these
servrces_
3. Geographic areas not authorized - Please note that you do not have authorization
from the chief law enforcement office from each primary jurisdiction that you have
listed on your permit application.
You will need to receive authorization from the following entities in order for your
renewal application to be processed:
For city streets -gain authorizatiop
cities that you had originally listed:
Seattle and Tacoma.
from the Chief of police for the following
Auburn,,Federal W?y, Fife, Puyallup,
: ; ;i. :, ." ,:. .:,.'t ..r,
For c.ounty roads ;ga.in authorization from the sheiiff tor:ihe following
counties that you had originally listed: Pierce, King, Kitsap and Sfafi'it.
a
b
c For State Routes and lnterstates - to gain authorization from the Washingtonstate Patrol District commander in ch-rge of each area. since you havj
, Page 3
Mr. Chiswell
May 5,2011
listed all State Routes and lnterstate 5 and 90 in your_a.pplication, this would
require'tne JJoiiioniisignatule of the following WSp oistrict Commanders:
. OistiiCt 1 (pierciand Thurston Counties) - Captain Jeff DeVere
(253) 536-6210 , ,- , s. oistrici + (Spofane, Lincoln, and Adams Counties) Captain Jeff Otis
(509) 227-6566
. Oistrici S lClart<, Lewis, and Cowlitz Counties) Captain Ronald Rupke
(360) 260-6333 h_r^,:14 'r. Oistiict O (fittitas, and Grant Counties) Captain Karen DeWitt (509)
663-9721
Please amend your permit applicatio. n to remove the geographic areas,not authorized'
or return your" ren"*'li jppt''iaiion with the additional authorizations so that we can
process your request.
4 Operators: Your application does not.include the list of op,erators you intend to have
;fih;i6d under VJ,.it p"itit. Please include under page 3, the list of operators you
wish to have apprbved under your permit.
currenily we have only approrlg.d yourself (Tim chiswell),,Forrest Don Huiatt, and
J"niJJ rVr"c-ajr. rr there are additionat operbtors that should be added to your permit,
pG;; naue lnem .Jrpr"t"l11g61n1i.16ards and send them along with a processing
fee of $45,25 p"r p*dn to: W"ashington State Patrol, Equipmenf and Standards, PO
Box 42600, OiYmPia WA 98504-2600.
We have received the fingerprint cards for Mr. Kenneth Nishiyori and wjll send-them in
ior-pioi"sing "nd
*iff ieiyou know.once the results are received whether or not he is
"pprou"o
und'er vout p"iniit.-ni oi the date of this letter he is not authorized to
obbrate a vehicle under your permit.
SincereJy, y' ,q
/,r',,ffi.A-
ca{tain i"gdn c. 7€rrv
government and,,ffiledia Relations
please ensure alldocumentation and/or changes as outlined above are made and return
your application to our office for processing'
lf you have any questions please call Ms. Melissa Van Gorkom at (360) 596-4017 '
JGB:mvg
Enclosure
cc: Chief James Arsanto, Buckley Police Department
Chief Blackburn, Fife Folice Department
Sheriff Steve Boyer, Kitsap County Sheriffs Office
Captain Steve Burns, District 2 - Bellevue
Chief Jim Collyer, Puyallup Police Department
Captain Jeff DeVere, District 1 - Tacoma
Captain Kareri DeWitt, District 6 - Wenatchee
Chief John Diaz, Seattle Police Department
Chief Bret Farrar, Lakewood Police Department
Chief John Galle, Sumner Police Department
Page 4
Mr. Chiswell
May 5, 2011
CaptainKenGinnard, DistrictT-Marysville' : ..,,'., 1.,.,. :,,
Sheriff Rick Grimstead, skagit County Sheriffs.Office .' ":., :., : i-,,:.:i ,,.. ..,,,
9l',t"1 4ndy Hwang, Federal Way potice Department
Chief Robeft !-ee,,Auburn Police Department, ; :' ' ' .,:,' ;. i' .ii .'- *
Sheriff John Lovick, Snohomish County'sheriffs Officei 'i' ' : i .' :ii
Captain Jeff Otis, District 4 - Spokane
Sheriff Paul Pastor, Pierce County Sheriffs Office
Chief Linda Pillo, Bellevue police Department
Sheriff Sue Rahr, King County Sheriffs Office
Chief Don Ramsdell, Tacoma police Department
Captain Ronald Rupke, District 5 - Vancouver
Captain Steve Sutton, District 8 - Bremerton
Chief Ken Thomas, Kent police Department
Ms. Melissa Van Gorkom, Equipment and Standards
Chief Jim Zoll, Enumclaw police Department
Northwest Moton Escont, LLC"
1915 KlbterAve.
Enumclaw, WA 98022-331 1
253S53-0380
AFft [t ir ?$,{
March 30,20ll
Chief Ken Thomas
Kent PoliceDepartment
2zo 46 Ave. South
Kent, WA 98063
XENT PCILIAE iIUEFARNMENT'
Dear Chief Thomas,
The current Authorized Emergency Vehicle Perrrit issued to Northwest Motor Escort is due for renewal.
I am submitting the 2011 W.S.P. permit application to your office for review and consideration.
If the Kent Poiice Department would please sign ofron the AEVP, it would be appreciated.
We are a small company of off-duty public safety professionals, \pith a mission of positive change for the
funeral escort industry. Thank you foryour cooperation in this matter'
Respecffirlly*\;; LV.--
Tim Chiswell
RECEIVED
CHIEF'S OFFICE
"','f*4 lr rl
AUTHORIZED EMERGENCY VEHICLE PERMIT
APPLICATION RENEWAL
WASHI NGTON STATE PATROL
EQUIPMENT & STANDARDS REVIEW UNIT
GEN ERAL ADMINISTRATION BLDG
PO BOX 42600
oLYMPTA WA 98504-2600
DATE APPROVED
VALID UNTIL:
CAPTAIN
(For Departmeht Use OnlY)
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)hl o * F\^' *^r AE $T'oR Eeooa-r
Address \ q t€-\{. ria,i Ff{Aua
City f\.1 \J LL state \n-l A zip 2",-j.3r.\
Phone Q:l3) 6Ej - o3g,>E-mail l*l.\ f.-\4 tg t\ r-t
N oA. Tt{\J G6"( $4 o{::({6. SCc>R'.( e 3*o t\. c crr
Vehicte lnformation: List all vehicles being used as authorized emergency vehicles. For each vehicle,
provide both the vehicle and emergency equipment information as outlined below. Any new vehicles-or
,
vehicles with equipment installed other than what is authorized on the current permit for that vehicle-must
receive prior approval before being utilized under this permit:
LtrM
LICENSE NO.
b
YEAR
Q\\
\\- D FUHT? t
MODELMAKE
VIN
\Rb { trt\,atlr\r?-\3"\3f-\f qq? _
Geq 'd\Sbr
ERREGISTERED
SIREN
PN
[f r-nrvre coloR(s)
MAKE/MOD
OTHER EQUIPMENT:n
\t t+RiEXI
VJueuer)*-4C=
\S e
NZ-\J b-)
OTHER EQUIPMENT:
LICENSE NO.
Zott
YEAR
\{-D Fr-\{R.- P t
MAKE MODEL
VIN
REGISTERED OWNER.Ttnr+€sr \\., rn-r -l-
3000-323406 (R 1209)Page 1 ofS
AUTHOR IZED EMERGENCY VEHICLE PERMIT
APPLICATION RENEWAL
SIREN
VIN
IVIAKE ,{ii, MODEL
REGISTERED OWNER
LAMP COLOR(S)
OTHER EQUIPMENT
LAMP ODEL
SIREN
LAMP COLOR(S)
LAMP MAKE/MODEL
I r-nn,tn coloR(s)
LAMP MAKE/MODEL
YEAR LICENSE NO.
MODELMAKE
VIN
TSTEBED OWNER ,REG
MAKE MODEL
-r'i .- -VIN
SIREN
fl r-nnrp coloR(s)
LAMP MAKE/MODEL
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 12/09)Page 2 of 5
AUTHORTZ.FD EMERG ENCY VEHICf E PERMIT
APPLICATION RENEWAL
H.HHffiWtr
2.Purpose of Application: Describe the specific purpose for which the vehicle(s) shall Qe qged,as . .
authorized
"m'uig.nry
vehicle(s) and wh?t neces'sitates the vehic!eg.' reglstr-alr'o1;r as emergericy vql]lgleq'
Ex;llain the naturi "nd
rcope Of'the duties,'responsibility, and intended use of emergehcy equipment'i''r-'' '
Authority: Exptain authof'rty outtined rffide.r*statute (Revised Code of Wag!ington) that allows the vehicles'
operatori to use emergency equipmbnt for'the purpoBe outlined under part 2 of this application.
i i:il".,sk
3.
4. Geographic Ar-ea: Check which types of roads you will be operating on and state the specjfic geographic''
icles shall be used as authorized emergencY vehicles (city,,county, etc.).'
jurisdiction.is required u nd9,[ poa rt7 of this application.) '
City Streets (list all citi CS \-(.,Bct\'.r rr
k(s' r":r A\(tw s or:U e..t"FI
tr County Roads (list all counties)tN r"4
Kr AP
-1s
F: tr-\*i tE
4
)
tr StateRoutes/lnterstates 5
.I:.
5. Operators: Please list all drivers tlrat you intend to have
rT+ -
not the operator/driver is'new since
,:l
' - rl{.'ti' '. €
g the vehicle(s) listed in this application
last application
,I
-qo - qo \
and indicate whether
:.- r{-::''. i. '"-
4L"30-t. tqbr}t-tu
ieiv rR
ER,V1Ct'S \,e.*t i.D {, e.3e 'o
f '+u 3T.\qt
'i rlL\}JLZ Ab\+/s
\rJ tr".t
+. 3000-323-006 (R 1Zo9)
(Use additional sheet if
Page 3 of 5
AUTHORIZED EMERGENCY VEHICLE PERMIT H,R"HMWtrAPPLIcATIoN RENEwRTE
i . '*:
i-'. . ::. ;,-, ::E :, ,'
:_ r'J,:,.,j:.t.i t. -.
(if the icle
provided'in
is to be used
are to be used as
I understand that'the inappropr,iate or misuse of authorized emergency"vehicles may result in criminal or civil
liability 'as well as cancelidtion of this p"mit as outlined. under chipt ei zpq-ga WAC: r,,
b. None of the driver;s; io the best of my knowledge in the ladt year, have been convicted of, nor served
any sentences or periods of probation for any fe.l-onies, nor arrested and conVicted of a-drug or alcohol
violation or illegal use or possession of drugd, n5r been required to register as a 6ef off6ndlr, nor
havq,i.any of them been adjudicated incomp-etent or insane,.
c. O4ly the vehicle(s) and equipment listed in this application vvill be used as outlined in this application,
and that only the operatbrs listed under this permit wiil d,1iye the vehiclb(s).
I
l" tlq Pllnary holder or executive officer in charge of overseeing this permit, I understand that if the permit is-
rssued, I ts my responsibility to ensure:
a. No driver listed in this permit uses the vehicle for private purposes unless all emergency equipment is
removed or covered.
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 vehidle to this permit, I
must receive pridr approval befor'e they are authorized under this permit.
The driver must exercise due care and caution and must obey all traffic laws.
b
ln.addition, I u_nderstand that it is my respons[bility
drivers are present in each vehicle it ail times anb
'i' 'j
sisnature { UW"-'-'cA0
(cHtEF EXECUTTVE OFFTCER)
ATRor^rre > Q-Ar:;usLt L
to eniurettnat a copy of this.permjt and list 'of approved
must be presented to law enforcement, if requested; .
Title !r*..a**$
Date *-L\-zct\
jl,.:ir i '
Date
Jurisdiction'
E-Mail
Name
7
,ri- crY-PjE OR PRINT)
Certification: This renewal application for Authorized Emergency Vehicle Permits will not be accepted
unless'CERTIFIED by t!'re chidf law enforcement officer or fir6 chi'ef (if the vehicle is to be used for '
fireflghtihg pi.rrposes)-of each primary jurisdjction in which the vehicldstare to be used as authorized
emergency vehicles (see part 4 of this applioation). lf the application is made by the chief of a law
enforc-ement agency or fire department, il'frust Uej CfnftfiED by the head of the politicalsub-ciivision. The
certification must contain the following lan$uage:
"l hereby 9g4ifv that I have reviewed this entire application; that I am aware that the applicant intends to
use the vehicle(s) and emergency equiprnent listed bs specifically desiribed in part Z tif tniq"application; that
a lgqd continues to- exist in my jurisdiction for the listed vehicles to be used as authorized eryrergency
vehicles and that the applicanf has the.appropriate authority as de'scribed in part 3 of this alipticltionio
operate sug[4gttipment;and I know of no reason why this-application should bu 6"01"6.'t . . -
Pfease type or priht:
Signatuie ' -- :'-.
" ':".
,i:
l.l
IJame
(Ple1s!9 Print)
PhUne
Restiictions
3000-323{06 (R 12/09)
' "Lat "
Page 4 of 5 '?
AUTHORIZED EMERGENCY VEHICLE PERMIT
APPLICATION RENEWAL
mmm,-EisilfrcEf3ie=f7iEoIWtr
WASH INGTON STATE PATROL.
EQUIPMENT & STANDARDS REVIEW UNIT
GENERAL ADM IN ISTRATION BLDG
PO BOX 42600
oLYMPIA WA 98504-2600
Person, Company, Department, or Agency
(if a person, must list agency/department representing)
DATEAPPROVED
VALID UNTIL:
CAPTAIN
(For Department Use OnlY)
This application must be submitted by the Chief Executive of the firm or corporation making application.
i
Ptease type or print in ink.
hl $ r Fh -*r E.ET h{,o= " ru f scc,taf
Address \q\(. \4iG r trf{\J tr=l\
City E rq \J F'r g L AL,J
Phone (!*rr5) fr6j-OSBa
state \r--/ A Zip \"i Y-b rr'1l- t{-- <-<[
nr Ci4 t{l rt C€i-.}.'\E-mail
1
N oR tvlr.+E5.{ */t o{ ail*6. SC I 3r*o i\. c d'
Vehicle lnformation: List all vehicles being used as authorized emergency vehicles. For each vehicle,
provide both the vehicle and emergency equipment information as outlined below. Any new vehicles-or
vehicles with equipment installed other than what is authorized on the current permit for that vehicle-must
receive prior approval before being utilized under this permit.
2o\ \ \j,rv\ qe,Q e=
LICENSE NO.YEAR
\\. D FUHT? I
MODELMAKE
VIN
L RS ! F[r,\Nzt \?-Btse-\f,qq? -
REGISTERED OWNER-*. n\*crnrls t-rUSsleLL
i:;i+::i:*l NST,AEE E Diil"i:i :-: ::': : :,:rl:;lVl fi l(E .i,r.';
SDZI(}RE stnrru \**eUel} -[f r-nrvre coloR(s)
LAMP MAKE/MoDEL .WH*-E
\n l t+ EurN
\Juale r.) u(aef] orngn EeUTPMENT:
L]CENSE NO LYEAR
ir
\-\ -Ft-t+G.- T:\
MAKE MODEL
o\ \a A3\\
VIN
\S
EI r-nr',rP coLoR(S)
LAMP MAKE/MOD
OTHER EQUIPMENT:
VJt+€t-Et-J LtNz-
3000-323-006 (R 12lO9)Page 1 of5
AUTHORIZED EMERGENCY VEHICLE PERMIT
APPLICATION RENEWAL
mmm,-,
F(sfiirciST-CiIiEEiE6iWT
YEARl"ri,i.,,,'.: Ll
IVIAKE 'ri', IVIODEL
VIN
REGISTERED OWNER
,EI
Ll srnrru
LAMP COLOR(S)
LAMP MAKE/MODEL
[_] ornrn EeutPMENr:
f stnEru
fl r-nnrp coloR(s)
LAMP MAKE/MODEL
ti;;i-;ir;,=;.'-I.iii+:;i7f,Ii i:iwri:?ii.,r-ll,,ii_:+;ii:-.+.:.i;1,.-Y. ii
iE#l N,STAlj,l;FPl'lri'.,,:.,'+',i#.fi #i'i tUt'AKF,t+ii,,,
SIREN
Lj r-nrvrp coloR(s)
LAMP MAKE/MODEL
LICENSE NOYEAR
MODELMAKE
MAKE MODEL
MODELMAKE
ISTERED OWNER .REG
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 12/0s)Page 2 of 5
mmm.-
FisF-nc6ix'3iffiEiFot-Wtr
purpose of Application: Describ.e the specific purpose for Which the vehicle(s) shall Qp u9eg,?s. : .
autnoiizlO "rL'rg.ory
u"ni"t"1r; anc wlGilG6siit"ies the vehicles' reglsllation as emergency Yen!gF9,
r*pi"i;tin. natui" ini Scope orihe duties, responsibility,'ald intended use of emer:gehcy equipment.i; ', '
Authority: Explain
"'rtnorTq,
outlined u*deg,statute (Revised Code of Wagfington) that allows the vehicles'
operators to use emergency equiprnQ.pt foratfre purpole outlined under part 2 of this application'
AUTHOR LZSD EMERGENCY VEH ICLE PERMIT
.APPIICRTION RENEWAL
lrT Ln'<EwsDE"
tr County Roads (list all counties)\LI
r€A?
i El State Routes/lnterstates 5 o 1 - LIO b
t6\
2
, PilA\
3.
4 geographic '
f"4
\
application. ':;.-li, ' : '
q 4
5. Operators: Pl€ase list all drivers that you
, ?1,-d indicate.,whpt[rer qr ngt the operator/d
E's .
intend to have
river is-new since
*_q
the vehicle(s) listed in this application
onal sheet if necesSarYJ
SER.VIC€S \J
4L.3\ " rqc,
f-: r
{^/
WV
cr-+ i P {"
/ +a,3Y. \qt
\L\Z r Nl6 '*Jaft6,ti$& bS,!e$(O
\ r'/
,i,*
r*''t
VJe
R,C
tr
!
u
D
D
u
[]
u
n
D
u
tr
,il.!".:,,:|i:;tr
tr
tr
tr:I
u
f1
u
;,. 30oG.323406 (R 1209)
(Use ad
- Page 3 ofS
AUTHORIZED EMERGENCY VEHICLE PERUIIT
.APPLICATION REN el+ii
6. Peimit Validation: .; ::: ; ".. ':'' ''" ': ''' t*
I certifyi thatt'-;':."1 ".
' a' All of th6 i,nformationrgiven in this Fppliiation is correct to the best o-f my knowledge ahd drovided in
its full forrirat to ttre uioersigned ch?eii"* ".r"t""rlri onrcei"r'il ;h1"i iif ilu''i"nm i!:t" o" ri"o
for firefightifig pur:poses) 9l ga9l primary jurisdiction in which the vphicles ire to be used as
authorized ernergency veh icle(s).
b. None of.the driveqs; to the best of my knowledge in the ladt year, have been convicted of, nor served'
any sentenees or periods of probation for any fe].onies, nor arrgsted and conVicted of a-drug or.alcohol
violation or illegal use or possession of drugs, n5r been rdquiied tcj register as a 6ef offdnd-er, nor
have any of them been adjudicated incompetent or insane.
c. 04ly the vehicle(s) and equipment listed in this application Will be used as outlined in this application,
and that only the operatbrs listed under this permit will drive the vehiclb(s).. ' .E{ ifill 1i$,,
$.1!9 qlif?ty holder or executive officer in charge of overseeing this permit, I understand that if the permit is'
tssuecl, it is my responsibility to ensure:
a. No driver listed in this perryit uses the vehicle for private purposes unless all emergqncy 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 wjp'h to add'a new driver or vehille 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 m
liability'as wellas'cancelidtion of this pe
isuse of authorized emergency vehicles may result in criminal or civil
rmit as qullilgfl:;gng-e,r chapteiz04-36 WAC: ,,,,'.,..,,t,,".,
Signature
Name
(cHlEF EXECUTTVE OFFTCER)
Title
Date
7
$ (TYPF OR PRINT)
':*
Gertification: This renewal application for Authorized Emergency'Vehicie Permits will not be accepted
unless"CERTIFIED by the chi6l law enforoement'officer or fir:e chibf (if the vehicle is to be used for '
.firefighting pirrposes) of each primary jurisdiE'tion in which the vehicl6s$are to be used as authorized : '' '
en'lergency vehicies (see part.4 of this application). lf the application is rnade by the chief of a larv
enforpement agency or flre department,'['5ust be CERTIFieO Oy the head of the political sub-division. The
certification must contain the following language:
"l hereby cg4ifY that I have reviewed this entire application; that I am Aware that the applicant intends to
use the vehicle(s) and emergency equiprnent listed bs specifically desdribed in part 2 o1'this application; that
a need continues tq exist in my jurisdiction for the listed Vehicles 1o be used as authorized erneigency
vehicles and that the applicani has the.appropriate authority as described in part 3 of tnis apptication-to
operate such equipment;.and l"know of no reason why this-application should be denied.'f :
; , i..r;-.;;.,-_,
Plea-Se type or priht:
--, !r . ., ... I ;.
{r:,.. ' ii.i
SignaitUf€
Name
"Date
Jurisdiction
E-Mail
i:1;:'I j:
(Plerc
Ph'o
Print)
ne ()
Restii ctions
3000-323{06 (R 12/09)Page4of5 ':
AUTHORIZED EMERGENCY VEHICLE PERMIT
APPLICATION RENEWAL
EEM_wrsll!.GToN srAlE PTTRoL
WEEtr
7
vehicles
operate
Signature
Certification: This renewal application for Authorized Emergency Vehicle Permits will not be lrccepted
unless CERTIFIED by the chief law enforcement officer or fire chief (if the vehicle is to be used for
fireflghting purposes) of each primary jurisdiction in which the vehicles are to be used as authgrized, : . , .
emergency vehicles (see part 4 of this application). lf the application is made by the chief of a law
enforcement agency or fire department, it must be CERT.IFIED by the head of the political, subdivision. The
certification must contain the following language:
"l hereby certify
use the vehicle(s
that I have reviewed this entire application; that I am aware that the applicant intends to
)and emergency equipment listed as specificall
urisdiction for the listed vehicles
yd
to be used as authorized emergency
escribed in part 2 of this application; that
a need contin ues to exist in my j
handtheicant as the appropriate authority as described in
such ipm nd I know of no reason why this application shou
Date
Jurisdiction
E-Mail
Date
Jurisdiction
E-Mail
part 3 of this application to
ld be denied."
C-\
?ltl rr ritre@
Name
(Please Print)
Phone
Narne
(Please Print)
Phone
*Tbl
2-
Restrictions
Signature Title
Restrictions
Signature Date
,E-Mail
Title.. r I ': ,'Name'
(Please Print)r ' ; .., : JUriSdictioh,,; : ., , ,. ,,,.r i
Phone ,. ()
Restrictions
Signature Date
Jurisdiction
E-Mail
Title
Name
(Please Print)
Phone ( )
Restrictions
Signature Date
Jurisdiction
E-Mail
Title
Name
(Please Print)
Phone
Restrictions
Signature Date
Jurisdiction
E-Mail'
Title
Name
(Please Print)
Phone ( )
Restrictions
Signature '
Name
Date
E-Mail
Title
(Please Print)Jurisdiction
Phone ( )
Restrictions
lf additional certifications are needed, add an additional sheet.)
3000-323-006 (R 12/09)Page 5 of 5
Chief,
No Restrictions. As Des Moines PD Officer Bob Crane is part of
this business and Crane is a Police Motorcycle Escort Instructor that
we have also used for some of our in-house escort training, this
company should be squared away.
Robert
Feb. 5,2010
To: Chief S. Strachan
Kent Police Department
400 W. Gowe
Kent, WA 98032
Dear Chief Strachan,
please accept this application for a W.S.P. A.E.V. permit at the b€hest of Mr. Forrest Huiatt and Mr.
Thomas Chiswell, D.B.A. Northwest Motor Escort. We would request that you consider granting
certification by signing page 4 of the application.
Our intent is to raise the bar of excellence and the standards of the men and women working in the
motorcycle funeral escort industry. The employees, owners, and riders are comprised of Commissioned
Law Enforcement, Firefighters,.and Washington State D.O.T. workers familiar with trafrc procedures
and emergency safety protocols. We take pride in our positive attitude and appearance. We have no
intention of being mistaken for W.S.P. Motor Officers. No one will be wearing a sidearm, or anything
with the State Seal. We acknowledge the fact that we are a State Certified "Traffic Flagge/' on a
motorrycle, and will behave accordingly.
Thank you for authorizing our A.E.V.P. application on behalf of N.M.E. Please rest aszured that we will
conduct ourselves to the highest professional standards. Ifthe City ofKent requires any additional
information, we will gladly comply.
Respecffiilly,
fi;^.^'L\;*'"9-P
Thomas Chiswell
l9l5 Kibler Ave.
Enumclaw, WA 98022-33 I I
253{534380
AUTHORIZED EMERGENCY VEHICLE PERMIT .
ORIGINAL APPLICATION .
WASH INGTON STATE PATROL
PO BOX'42600 ;,",,. i
OLYMPIA.WA 9p504:2600
Please type or print in ink.
Person, Company, Department, or Agency
(if b person, must list agencyldepartment representing)
EQU]PMENT & STANDARDS REVIEW UNIT VALID UNTIL:
GENERAL ADMI N ISTRATION B LDG CAPTAIN
DATE APPROVED:
.l
'-,.i
(FoI
:"1:
Department Use Only)
This application must be submitted by the Chief Executive of the firm or corporation making'applicatibn.
fa
Address
.:
N.,rrhVest tt\crf.ta EE..df
tr"," \Ja l,lCity
1. Vehicle lnformation: List allvehicles you intend to use as an authorized e
For each velicle, provide both the vehicle and emergency equipment
note that the emergency equipment may not be installed on these vehicles until th
are obtained for this application and temporary vehicle permits have been issued.
\K,
w 3\i
Phone ('rqe ) 463 -OaQ,e'E-mail TrStC*tfSWa Li(O-rtl*tc>o . Coq-
-''l ': 't .t..i i
vehicle
outlined
(if approved)..
belotv. Please
approqrFl: siqnqJl re,s
."i ,j '.. t ' ' ..,-'"
YEAR
2org
LICENSE NO.
t\*e.t-Ev FurAT- ? t
MODELMAKE
REGISTERED OWNER
.n C\{(gwtl-L
SIREN
uEd
El r-nrvrp coloR(s)
LAMP MAKE/MODEL
D
OTHER EQUIPMENT;
YEAR
2oro 6AtoTe
LICENSE NO
MAKE
ldrq.uev
MODEL
trL_t\
:. \{D 1 Fl{h^ \'l- A8 g [ \t 3L<
VIN
REGISTERED OWNERDo*, tA.rr AfT
l-l orHe n EoUTPMENT:
-,
i' - ..'
SIREN
LAMP COLOR(S)
LAMP MAKE/MODEL
3000.323-006 (R lZOs)Page 1 of4
AUTHORIZED EMERGENCY VEHICL
OruGINAL APPLICATION
E PERMIT i
H,H"H*mW
VEHIC LE INFORMATION J
LICENSE NO
6lYEAR
oo
MODEL
VIN
FttPr t
MAKE
OWNER
A NDJ€R'
REGTSTERED
rA
EMERGENCY EQUIPME INFORMATION
MODELlrusrAllro
SIREN
I r-ert/lP coloR(s)
LAMP MAKE/MODEL
G.
OTHER EQUIPMENT:
RfrlnftOru
i MODEI-
EQU PME
LED
SIREN
LAMP MAKUMODEL.
LAMP COLOR(S)
'L\tDt Ft+t-rr r t\ Y Btstonq,
REGISTERED OWNER
J*rp> Mevtres
YEAR
MAKE
FT
DEL
VIN
MO
' 'I i'
LICENSE NO
YEAR LICENSE NO
cicQ"''Rto
MAKE ,M
H r\'
VIN
a!\DLFL\t'\r zz\Y GI\
REGIST OWNER
Note: you may add an additional sheet if more vehicles need to be added to the permit' Any additional sheets
*uti-ptouiOe itie veniOe-and equipment information in the same format as above'
Puroose of Application: Describe the specific purpose for w.h
authorized drn'eigeniy vdhicle(s) and what necessitates the ven
E-ii"i. tn" naturt and"seope of'the duties, responsibility, and in
ich the vehicte(s) shall be used as
icles' registration,,as emergency vehicles'
tended use of emei'gency equipment.
2
\le G,sc,oa,{ FuilERAL gEe'vlcEs
SIREN
LAMRCOLOR(S)
LAMP MAKE/MODEL \^/\r,e-
OTHER EQUIPMENT:
iL. ':J'a t
3000-323-006 (R 12y09)
Page 2 ol 4
t H"R"qmWTAUTHORIZED EMERGENCY VEHICLE PERMIT
OR IGINAL APPLICATION
3 Authority: Explain authority outlined u.nder statute (Revised code of washington)
il;l;i;;J i";'":#;;d;nci "qriptent
for the purpose outlined under part 2 of this
Area:Checkwhichtypesofroadsy'ouintendtooperateonandstatethespecific
ich the vehicles stratt # usea as auihorized emergency vehicles (city' county' etc')'
from each primary irrlaiirn is required under part 7 of this applicatiqn.)
1
:
ihat allows the vehicles'
application.
geographic4. GeograPhic
area(s) in wh
(Certification
tr
tr
E
Operators:
Please note
operation of
City Qtreets (list all cities)E Er{
tVf,lse tquqbt Ko tl\tooD t{Prcor
Roads (list all cou )Ktw
Routes/lnterstates lqo I, rto6
se list all drivers that you intend to have operating the vehicle(s) listed
I
rfs&?
I
5 Plea
that these drivers willbe requ ired to undergo a backgrou
$to
in this aPPlication
nd check an be approved Prior to thedj
ny emerg ency vehicle listed i n this aPplication
(Use additi I sheet if necessary )
6.
S
N
W.t\ l.C , 2o"r -36'O?of o GO
ERUF{€q,
3tr1,g p\d.
tJ-,u.tt-\t(UcEgte.AL\JvgOoRTwVE t C}q Lt BFl\e j r{q
d
3000-323-006 (R 1Zo9)
(TYPE OR PRINT)A.TT'
Page 3 of4
AUTHORIZED EMERGENCY VEHICLE PERMIT I
ORIGTNAL APPLICATION .
H.E*"HimWT
7
Please type
Signature 'ffi18b ritre,
-l
Ction
.'.:,i 'r ' :,'ii1 ,* ,
certification: This renewal application for Authorized Emergency -V.e-hicle
Permitq will not be accepted
unless 6ERTIFIED bi ihe "ni"ir"* enforcement officer or fire chi-er 1if the vehicle is to be used for
firefighting purposesl'oi ;";h';ri;;tiurisdiction in which the vehicles are to be used as authorized
"r"ig;"EvGiii"i"r t#u-purt}' oi tnls -p-ppliJation) .t1-S.g.pp-lq"tion is made,bv the chief of a law
enforcement agencyoJinrE o"p"rt*uhd, it mulil,jtcEnnrirD by the- headrof'the poJitioa"l sl/bdivisioh' The
certiflcationmustcorttain.fhefoliowinglanguager. , ; j n : ..., ;"rI';.. '.', ,'-. * .,- t, I
\ '' f
,,1 hereby certifv that I irave reviewed this entire apptication;.that,I qm aware that the applicant intends to
use the vehicre(s) ."i ;;;;;;; Arifi;;liistti t" spieiifica.tty iiescribed in par'r2 of this application; that
a need exists in my luriioiit'r"on tor tnb tisteo vJni"reg to 6e useo is authorized *.n"ig"::ljetricles'and that
irre applicani 6as t'n6 appropriatei'authority as described in p5rt 3 of this'applicatiorito operate such
;qripfi;;t;' jnd I fnow'dl nb reason wny inls application should be denied'"
:
orp
* lName'
fPlease Print]
.
Phone.tt'Rebtricti
Signature,
Name'
ons il1
Date
t' ,:
Jurisdi
E-Mail
Title
I;
(Pleass Print)
Phone
Restrictions
Signature
Name
(Please Prinl)
Phone
Date Title
Jurisdiction
E-Mail
Restrictions
Signature Date Title i
Name
(Please Print)
Phone
Jurisdiction
E-Mail
Restrictions
Date"
Name
(Plsase Print)
Phone
Jurisdiction
E-Mail
Restrictions
Signature Title
Name
(Please Print)
Date
Jurisdiction
E-MailPhone (
Restrictions
Signature
Name
(Please Print)
Date
Jurisdiction
E-Mail
Title
l
Phone (
300G323{06 (R 12109)
:'.i
Page 4 of 4
Restrictions , ,
(lf additional certifications are needed, add an additional s heet.)
t
Additional Page
Pete Noetezl
Jim McCalt
Bob Crane
Melissa Irish
2009 Harley-Davidson FLH VIN # lHDlFHMt78Y650363
WA#LEM9188 WhelenSiren- SD210R Whelen Strobes'Red
2009 Harley-Davidson FLH VIN # rI{DIFI /1129Y6277817
Wa#PF9510-5 Whelen Siren- SD2IOR WhelenLED-Red
Kennetlr Nishiyori 1989 Kawasaki K21000 vIN 3JKAKZCP22I<85O6641
Wa #831877 SA450'Siren Whelen LED Red/White
2009 llarley-DaviGon FLH VIN # 1I{DIFHM109Y69286I
WA #5A7093 Whelen Siren-SD2l0R WhelenLED-Red
2009 Harley-Davidson FLH VIN # tqD t trU f'^ \ G t Y t"3ge\ c'
WA # 4A3S52 Whelen Siren-SD2lOR Whelen Strobes-Red