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Home My WebLink AboutCAG2023-074 - Original - Premier Motor Escort, LLC - Authorized Emergency Vehicle Permit Application - 02/09/2022Ap p r o v a l Originator:Department: Date Sent:Date Required: Authorized to Sign: Director or Designee Date of Council Approval: Grant? Yes No Type: Re v i e w / Si g n a t u r e s / R o u t i n g Comments: Date Routed to the City Clerk’s Office: Ag r e e m e n t I n f o r m a t i o n Vendor Name:Category: Vendor Number:Sub-Category: Project Name: Project Details: Agreement Amount: Start Date: Basis for Selection of Contractor: Termination Date: Local Business? Yes No* Business License Verification: Yes In-Process Exempt (KCC 5.01.045) If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace. Notice required prior to disclosure? Yes No Contract Number: Agreement Routing Form For Approvals, Signatures and Records Management This form combines & replaces the Request for Mayor’s Signature and Contract Cover Sheet forms. Visit Documents.KentWA.gov to obtain copies of all agreementsadccW22373_1_20 Budget Account Number: Budget? Yes No Dir Asst: Sup/Mgr: Dir/Dep: rev. 20210513 FOR CITY OF KENT OFFICIAL USE ONLY (Optional) * Memo to Mayor must be attached AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION E*RFffiumF WASH I NGTON STATE PATROL EQUIPMENT & STANDARDS REVIEW UNIT GENERAL ADMI N ISTRATION BLDG PO BOX 42600 oLYMP|A WA 98504-2600 Person, Company, Department, orAgency (if a person, must list agency/department representing) DATE APPROVED: VALID UNTIL: CAPTAIN: For Use On PREMIER MOTOR ESCO LLC This application must be submitted by the Chief Executive of the firm or corporation making application. Please type or print in ink. Address PO 80X55634 1 City SHORELINE State WA zip 98177-0634 Phone 12061542-4763 E-mail prem i e rm otorescort@comcast. net purpose of Application/Authority: Describe below the specific purpose for which the vehicle(s) will be used as autnoii2eO 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. Authority: RCW 46.37.194 WAC Chapter 204-36 wAc 308-330-466 wAc 204-36-050(3) 3000-323-006 (R 8/15)Page 1 of 7 EmEl-'ueHrrclot 6t E illio!GIHF Vehicle lnformation: List all vehicles intended to be used as authorized emergency vehicles. For each uenicf", provide all vehicle and emergency equipment information as outlined below. Prior approval must be giuen b'e'ioie utitizing a new vehicle oi a v6niite with equipment installed other than what is authorized under itilluirent perm-n fo"r tnat vehicle. Proof of insurance fbr'each vehicle must be attached pu.rsuant to. WAC tb4-:6-03b: 1f providing funeral escorts, proof of commercial insurance in Washington State or business use exernfiion hrust be provided pursuant to WAC 204-36-040. AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION 2 VEHICLE INFORMATION 1 YEAR 201-2 LICENSE NO 7G8660 MAKE HONDA MODEL STl3OOP VIN JH2SC513XCK000014 REGISTERED OWNER THOMAS P DEBARTOLO VEHICLE INFORMATION 2. YEAR 2009 LICENSE NO 5F4039 MAKE HONDA MODEL STl3OOP VIN JH2SC51769K600684 REGISTERED OWNER THOMAS P DEBARTOLO VEHICLE INFORMATION 3 YEAR 2006 LICENSE NO oGt243 MAKE HONDA MODEL STl3OOP VIN JH2SC51716M400294 REGISTERED OWNER THOMAS P DEBARTOLO VEHICLE INFORMATION 4. YEAR 1999 LICENSE NO 4F4096 MAKE MODEL KAWASAKI KZ1OOOP VIN JKAKZCPP2sXB517259 REGISTERED OWNER 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. EMERGENCY EQUIPMENT INFORMATION INSTALLED MODELMAKE WHELENX stneru NZ6 LINZ6 500+LlN26+TlR3 LAM P(S) (location/colors) WHELENFRONT - WHELENSIDES _ REAR - RED WHELEN OTHER EQUIPMENT WH EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL X srneru WHELEN lwpnrz NZ6 500+LlN26+TlR3 N26 LAM P(S) (location/colors) WHELENFRONT _ WHELENSIDES - REAR - RED WHELEN H OTHER EQUIPMENT 3M OPTICOMCLEAR STROBE EMERGENCY EQUIPMENT INFORMATION INSTALLED MODELMAKE SIREN t2WHELEN NZ6 500+LtN26+TlR3 NZ6 LAM P(S) (location/colors) FRONT - SIDES - REAR - RED WHELEN LEAR WHELEN LEAR WHELEN OTHER EQUIPMENT: CLEAR STROBE NOVA EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL WHELENSIREN L2 +TlR6 TIR6 500 LAMP(S) (location/colors) WHELENFRONT - R WHELENSIDES - R WHELENREAR - RED OTHER EQUIPMENT: 3000-323-006 (R 8/15)Page 2 of 7 AUTHORIZED EMERGENCY VEH ICLE PERMIT APPLICATION F"F""HffiUHF 2 Vehicle lnformation: List all vehicles intended to be used as authorized emergency vehicles. For each uenicf", provide all vehicle and emergency equipment information as outlined below. Prior approval must be oiven b'efore utilizinq a new vehicle oi a v6niite with equipment installed other than what is authorized under if'eiuirent permit fdr lnat vehicle. Proof of insurance fbr'each vehicle must be attached pu.rsuant to. V/AC. ib4-46-mb: lf providing funeral escorts, proof of commercial insurance in Washington State or business nse exernption hrust be provided pursuant to WAC 204-36-040. VEHICLE INFORMATION 5. YEAR 20L7 LICENSE NO 9208LEM MAKE HD MODEL FLHTP VIN 1HDlFMC13HB643262 REGISTERED OWNER JULIUS PARNICZKY VEHICLE INFORMATION 6 YEAR 201-7 LICENSE NO 7E9LO1 MAKE HD MODEL FLHTP VIN 1HD1FMC1XH8655974 REGISTERED OWNER JOHN HYBRIDGE VEHICLE INFORMATION 8. YEAR LICENSE NO MAKE MODEL VIN REGISTERED OWNER 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. EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL WHELENX stnru lwpnmz LIN3 26 ARRAY 500 LAMP(S) (location/colors) WHELENFRONT - SIDES - REAR - RED WHELEN EAR WHELEN OTHER EQUIPMENT EMERGENCY EQUIPMENT INFORMATION INSTALLED MODELMAKE WHELENX stneu ls D210R SIDES - RED/CLEAR WHELEN NZ6 ARRAY 500 FRON T - RED/CLEAR WHELEN X mrrlrP(s) (location/colors) REAR - RED WHELEN OTHER EQUIPMENT VEHICLE INFORMATION 7 YEAR 20L3 LICENSE NO u1-285 MAKE CANAM MODEL SPYDER VIN 2BXNCBC14DV002916 REGISTERED OWNER VERN EARLJOHNSON JR EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL X stnrru WHELEN lwpnrz FORCER ENFORCER N LAM P(S) (location/colors) FRONT _ SIDES - REAR - RED WHELEN LEAR WHELEN LEAR WHELEN OTHER EQUIPMENT: EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODELtl LAM P(S) (location/colors) E ornrn EeUTPMENT: 3000-323-006 (R 8/15)Page 3 of 7 H"m*"qrmUEF Vehicle lnformation: List all vehicles intended to be used as authorized emergency vehicles. For each "Jnicri, prouioe jir vehicle and emergency equipment information as outlined below. Prior approval must be oiven before utilizinq a new venrcle oi a v6niite witn equipment installed other than what is authorized under t"ti;;il;i pJrr-n f& tnai venicfe. proof of insurance fbr'each vehicle must be attached-pu.rsuant to. WAC tb?:t6-mb: lt provioing funerat escorts, proof of commercial insurance in washington state or business use exemption hrust be provided pursuant to WAC 204-36-040. AUTHORIZED EMERG ENCY VEHICLE PERMIT APPLICATION 2 VEHICLE INFORMATION 9. YEAR 2006 LICENSE NO 4D9tt6 MAKE HONDA MODEL STl3OOP VIN JH2SC51706M400268 REGISTERED OWNER THOMAS P DeBARTOLO VEHICLE INFORMATION I 1 YEAR LICENSE NO MAKE MODEL VIN REGISTERED OWNER VEHICLE INFORMATION '12 YEAR LICENSE NO MAKE MODEL VIN REGISTERED OWNER 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. EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL WHELENX stnrru N26 +LINZ6 500+LtN26+TlR3 LAM P(S) (location/colors) WHELENFRONT - WHELENSIDES - REAR - RED WHELEN OTHER EQUIPMENT: VEHICLE INFORMATION 10. YEAR 2009 LICENSE NO 3J1-257 MAKE BMW MODEL R1200 VIN w8103880292Tt5446 REGISTERED OWNER THOMAS P DEBARTOLO EMERGENCY EQUIPMENT INFORMATION INSTALLED MODELMAKE RT-PCODE 3SIREN 01 TSX3 LAM P(S) (location/colors) CODE 3FRONT - R SIDES - CODE 3REAR - RED ITE CODE 3 OTHER EQUIPMENT: EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL fl stnrru LAM P(S) (location/colors) OTHER EQUIPMENT EMERGENCY EQUIPMENT INFORMATION INSTALLED MODELMAKE I stnrru LAM P(S) (location/colors) OTHER EQUIPMENT: 3000-323-006 (R 8/15) Page 4 ol7 AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION F"H"Bffi[IJ[Hlr 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; othenryise, 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\{N1f,!0l!;!!;10z[Q)New? THOMAS P. DEBARTOLO - Expires: O3/2O24 ANTHONYJ DEBARTOLO - Expires: 7O/2O23 JOHN HYBRIDGE - Expires 6/2025 VERNON JOHNSON - Expires 5/2025 JULIUS PARNICZKY "- Expires: O5/2O24 ROBERT SETO - Expires 9/2025 TWYLA R DEBARTOLO- - Expires: O8/2O23 CHRISTINA R DEBARTOLO** CATHARINE M. DEVINE-- ,KPROY'DES TRAFFIC CONIROT SERY'CES ONIY. T'* PROVIDES VENUE CONIROT ONt}4 3000-323-006 (R 8/15)Page 5 of 7 AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION RR"RffiUEF 4. Geographic Area: lndicate which types of roads and which speqifiq geographic area(s) the authorized emeigency 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) X n 5. tr State Routes/lnterstates (list all state routes, interstates, and counties) 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 undelsigned 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, io 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 vehici-e(s) and equipment listed in this application will be used as outlined in this application, andthat 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 drivei othlr tnan 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 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. ln 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 Tom DeB Title Owner,Premier Motor Escort, LLC (CHIEF EXECUTIVE OFFICER) Name Tom DeBartolo 3000-323-006 (R 8/1 5) (TYPE OR PR|NT) Date 0912112022 Page 6 of 7 AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION E*E*Fffiuffi 6 Gertification: This application for an Authorized Emergency Vehicle Permit will not be accepted unless CERTIFtED by the cnidf taw enforcement officer or fire chief (if the vehicle is to be used for firefighting purposes) of dach primary jurisdiction in which the vehicle(s) are to be used as authorized emergency vehicles (see part 4 of thi! bpplication). lf the application is made by the chief of a law enforcement agency or fire department, it must b6 CERTIFIED by the head of the political sub-division. The certification must include the following language: "l hereby certify that I have reviewed this entire application; that I am aware that the applicant intends to gqe the vehitle(s) ind emergency equipment listed in part 2 of this application, for the specific purposes listed in part 1 of this application; tnat a need exists in my jurisdiction for the listed vehicle(s) to be used as authorized emeigency 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 ty Signatu Name (Please Print) Phone pe or print:re e/-{ (254\ <frlo-ffio Date 02. o?. e- Title Tt;el-oL'Pohtt Jurisdiction D+ Ket* E-Mail Date Title Jurisdiction E-Mail Date Title Jurisdiction E-Mail P46e( Pod;tlt+ Restrictions Signature Name Phone ( ) (Please Print) Name (Please Print) Signature Restrictions _ Phone ( ) Restrictions Signature Date Jurisdiction E-Mail Title Phone ( ) Name (Please Print) Name (Please Print) Name (Please Print) Restrictions - Signature Date Jurisdiction E-Mail Title Phone ( ) Restrictions Signature Date Jurisdiction E-Mail Title Phone ( ) Restrictions Note: This page may be copied if additional certifications need to be added to the permit. Any additional sheets ittacned must provide the certification information in the same format as above. 3000-323-006 (R 8/1 5)PageT ol7