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HomeMy WebLinkAboutCAG2021-133 - Supplement - Kent School District - Authorized Emergency Vehicle Permit Application - 10/31/2022 Routing Form • For Approvals,Signatures and Records Management KENT This form combines&replaces the Request for Mayor's Signature and Contract Cover Sheet forms. W A S H I N G T O N (Print on pink or cherry colored paper) Originator: Department: Jalene Police Date Sent: Date Required: > 1/5/2023 0 a- Authorized to Sign: Date of Council Approval: C 0 Director or Designee ❑ Mayor Budget Account Number: Grant? ❑Yes ❑ No N/A Budget? ❑Yes ❑ No Type: Vendor Name: Category: Kent School District Application Vendor Number: Sub-Category: c N/A Original 0 Emergency Vehicle Permit Project Name: g y E `0 Project Details:Emergency situations at various schools within the Kent School District c c a� Agreement Amount:0 Basis for Selection of Contractor: i Start Date: Termination Date: a Local Business? ❑Yes ❑ No* *Ifineets requirements per KCC3.70.700,please complete"Vendor Purchase-Local Exceptions"form on Cityspace. Notice required prior to disclosure? Contract Number: CAG2023-012 ❑Yes ❑ No Date Received by City Attorney: Comments: Im a+ 7 •� i � 3 C C1 Date Routed to the Mayor's Office: V1 Date Routed to the City Clerk's Office: aaccW22373_1_20 Visit Documents.KentWA.gov to obtain copies of all agreements AUTHORIZED EMERGENCY VEHICLE PERMIT °®GMNs APPLICATION 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) KENT SCHOOL DISTRICT- SAFETY SERVICES Address 12033 SE 256TH STREET, SUITE A-200 City KENT State WA Zip 98030 Kimberly.webb@kent.k12.wa.gov Phone (253)373-7256 E-mail Timonthy.kovich@kent.kl2.wa.gov 1. Purpose of Application/Authority: Describe below the specific purpose for which the vehicle(s)will be used as authorized emergency vehicle(s) and what necessitates permitting as an authorized emergency vehicle. The purpose should include the nature and scope of the duties, responsibilities, and intended uses of emergency equipment, as well as the statutes that give authority for the listed equipment and uses. These vehicles will be used to respond to emergency situations at various schools within the Kent School District. Additionally,the vehicles will be used to assist with school related emergencies at bus stops and on school buses. Chapter 204-36 WAC and RCW 46.37.190 provides for authority to use school district emergency vehicles for the purpose described above. 30W-323-OW(R 8/15) Page 1 of 7 AUTHORIZED EMERGENCY VEHICLE PERMIT ®®WON 6TAE KTR" APPLICATION a 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 2009 87297C ® SIREN WHELEN A315P MAKE MODEL ® LAMP(S)(location/colors) Chevrolet Tahoe LIGHT BAR red wht WHELEN 500 SERIES 1. VIN 1GNFK030X9R202196 REGISTERED OWNER ❑ OTHER EQUIPMENT: KENT SCHOOL DISTRICT VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2009 87298C ® SIREN FEDERAL SIGNAL 1500 SERIES MAKE MODEL ® LAMP(S) (location/colors) FORD CROWN VICTORIA LIGHT BAR red wht) WHELEN 500 SERIES 2. VIN 2FAHP71V49X134774 REGISTERED OWNER ❑ OTHER EQUIPMENT: KENT SCHOOL DISTRICT VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2015 A6260C ® SIREN WHELEN A315P MAKE MODEL ® LAMP(S) (location/colors) CHEVROLET TAHOE LIGHT BAR(red/wht) WHELEN LIBERTY SX 3. VIN PUSH BUMPER WHELEN ILEDS IONR 1GNSK3EC9FR552776 REGISTERED OWNER ® OTHER EQUIPMENT: R.WINDOW red wht WHELEN 4-LIGHTS KENT SCHOOL DISTRICT R.CARGO(red/wht) WHELEN IDES LEDS VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2015 A6259C ® SIREN WHELEN A315P MAKE MODEL ® LAMP(S)(location/colors) CHEVROLET TAHOE LIGHT BAR red wht WHELEN LIBERTY SX 4• VIN PUSH BUMPER WHELEN ILEDS IONR 1GNSK3EC5FR550510 REGISTERED OWNER ❑OTHER EQUIPMENT: R.WINDOW red wht WHELEN -LIGHTS KENT SCHOOL DISTRICT R.CARGO(red/wht) WHELEN IDES LEDS Note: This page may be copied if additional vehicles need to be added to the permit. Any additional sheets attached must provide the vehicle and equipment information in the same format as above. 3000-323-006(R 8115) Page 2 of 7 AUTHORIZED EMERGENCY VEHICLE PERMIT ®®,n„s® APPLICATION 2. Vehicle Information: List all vehicles intended to be used as authorized emergency vehicles. For each vehicle, provide all vehicle and emergency equipment information as outlined below. Prior approval must be given before utilizing a new vehicle or a vehicle with equipment installed other than what is authorized under the current permit for that vehicle. Proof of insurance for each vehicle must be attached pursuant to WAC 204-36-030. If providing funeral escorts, proof of commercial insurance in Washington State or business use exemption must be provided pursuant to WAC 204-36-040. VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2014 A4207C ® SIREN WHELEN A315P MAKE MODEL ® LAMP(S)(location/colors) CHEVROLET TAHOE LIGHT BAR red wht) WHELEN LIBERTY SX 1. \/I N 1GNSK2EOXER180797 REGISTERED OWNER ® OTHER EQUIPMENT: R.WINDOW red wht WHELEN 4-LIGHTS KENT SCHOOL DISTRICT R.CARGO(red/wht) WHELEN IDES LEDS VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2014 A4206C ® SIREN WHELEN A31513 MAKE MODEL ® LAMP(S)(location/colors) CHEVROLET TAHOE LIGHT BAR red/wht) WHELEN LIBERTY SX 2• VIN PUSH BUMPER WHELEN ILEDS IONR 1GNSK2EO8ER179468 REGISTERED OWNER ® OTHER EQUIPMENT: R.WINDOW red wht WHELEN 4-LIGHTS KENT SCHOOL DISTRICT R.CARGO(red/wht) WHELEN IDES LEDS VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2017 B4028C ® SIREN WHELEN A315P MAKE MODEL ® LAMP(S) (location/colors) FORD EXPLORER LIGHT BAR(red/wht) WHELEN LIBERTY SX 3. VIN PUSH BUMPER WHELEN ILEDS IONR 1FM5K8AR8H6A17722 REGISTERED OWNER ® OTHER EQUIPMENT: R.WINDOW red wht WHELEN 4-LIGHTS KENT SCHOOL DISTRICT R.CARGO(red/wht) WHELEN IDES LEDS VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2020 C3466C ® SIREN WHELEN A315P MAKE MODEL ® LAMP(S)(location/colors) FORD POLICE INTERCEPTOR AWD LIGHT BAR(red/wht) WHELEN LIBERTY SX 4• VIN PUSH BUMPER WHELEN ILEDS IONR 1FM5K8AB4LGA55671 REGISTERED OWNER ❑ OTHER EQUIPMENT: R.WINDOW red wht WHELEN 4-LIGHTS KENT SCHOOL DISTRICT R.CARGO(red/wht) WHELEN IDES LEDS 3000-323-006(R 8/15) Page 3 of 7 AUTHORIZED EMERGENCY VEHICLE PERMIT ®®�T�„T.N... 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 2021 C7275C ® SIREN SOUNDOFF 00 SERIES MAKE MODEL ® LAMP(S)(location/colors) FORD EXPLORER RED WHITE SOUNDOFF NFORCE 54 VIN GRILL- RED MPOWER 1FM5K8AB8MGC24270 DUAL CORNER RED/WHT MPOWER REGISTERED OWNER ® OTHER EQUIPMENT: SIDE WINDOW LIFTGATE(RED IMPOWER KENT SCHOOL DISTRICT REAR BACKUP LED RED VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN MAKE MODEL ® LAMP(S)(location/colors) 2• VIN REGISTERED OWNER ® OTHER EQUIPMENT: VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN MAKE MODEL ® LAMP(S)(location/colors) 3. VIN REGISTERED OWNER ® OTHER EQUIPMENT: VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN MAKE MODEL ® LAMP(S)(location/colors) 4. VIN REGISTERED OWNER ❑OTHER EQUIPMENT: 30W-323-OW(R 8/15) Page 4 of 7 AUTHORIZED EMERGENCY VEHICLE PERMIT 99 APPLICATION U)W. 3. Operators: Please list all drivers that will be authorized ho operate the vohicle(m) listed inthis application and indicate whether cx not the operator/driver k» new since your last application bv placing an)(inthe "New?"column; otherwise, leave this column blank. No drivers should be listed unless they have been approved. Per . all operators involved in traffic control must bea Washington State certified OagQer. and carry their certified flagge/card ot all times. AUTHORIZED EMERGENCY VEHICLE PERMIT 99 APPLICATION UJW. 4. Geographic Area: Indicate which types of roads and which specific geographic area(s)the authorized emergency vehicles will beused. Certification from each jurisdiction is.requiredunder Certification is covered in section 8ofthis application. City Streets (list all cities) C0V/NGT0N KENT County Roads (list all counties) KING Fl State Routeo/|nterotetee (list all state routes, intenototee. and counties) 5. Permit Validation: I certify (or declare) under penalty of perjury under the laws of the state of Washington that the foregoing io 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 ennerQencyvehic|e(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. o. 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, itisnny responsibility toensure: a. No driver listed in this permit uses the vehicle for any purpose not authorized under this permit unless all emergency equipment io removed orcovered. b. No driver other than those listed under this approved permit operates the vehicle(s) listed unless all emergency equipment is removed orcovered. |f|wish to add a new driver or vehicle to this permit, | must receive prior approval before they are authorized under this permit. o. 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 V24 Title Superintendent �CHIEF EXECUTIVE OFFICER) Nome lamml Vela [}aba (TYPE ORPRINT) ^ ^ AUTHORIZED EMERGENCY VEHICLE PERMIT ME ma ft� APPLICATION UJW. G. Certification: This applicationfor 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 4orthisapplication). If the application is made the chief cno 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: "| hereby certify that| have reviewed this entire application; that| ann aware that the applicant intends bnuse 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 oe described in part 1of this application to operate such equipment; and I know of no reason why this application should be denied." Please type orprint: SigO@fUn8 [)8fe Title SHERIFF Name (Please Print) 9ATTCOLE-TINDALL ]UriSdiCfiOO KING COUNT"''CO\/D1GTON Phone E-Mail F7eSf[i[tiODS Signature Date Title POLICE CHIEF Name (Please Print) RAFAELPADlLLA jU[iSdiCtinD DENTPOL[CE Phone E-Mail R8Sf[iCtiODS Signature ' Date Title N808 (Please Print) Jurisdiction Phone E-Mail Restrictions Signature Date Title Kj@Dl8 (Please Print) ]U[iSdiCtiOO Phone E-Mail Restrictions SigO8fU[8 Date Title Name (Please Print) jU[iSdiCfiOO Phone E-Mail Re8f[iCt/OOS Signature D2f8 Title Name (Please Print) jU[iSdiCfiOD Phone E-Mail ReGf[i{tiODS Note: This page maybe copied if additional certifications need to be added to the permit. AnyaddiUona| sheets attached must provide the certification information in the same format as above.