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Home My WebLink AboutCAG2023-074 - Application - Premier Motor Escort, LLC - Authorized Emergency Vehicle Permit Application - 10/06/2023 AUTHORIZED EMERGENCY VEHICLE PERMIT WAW ��"""'� rr.111 rory srrrt.rgoG APPLICATION I_�=L DATE APPROVED VALID UNTIL: CAPTAIN: WASHINGTON STATE PATROL EQUIPMENT & STANDARDS REVIEW UNIT GENERAL ADMINISTRATION BLDG PO BOX 42600 For Department Use Only) OLYMPIA WA 98504-2600 This application must be submitted by the Chief Executive of the firm or corporation making application. Please type or print in ink. Person, Company, Department, or Agency (if a person, must list agency/department representing) ' PREMIER MOTOR ESCORT, LLC Address PO BOX 55634 City SHORELINE State WA Zip 98177-0634 Phone (206) 542-4763 E-mail premiermotorescort@comcast.net 1. Purpose of Application/Authority: Describe below the specific purpose for which the vehicle(s)will be used as authorized emergency vehicle(s) and what necessitates permitting as an authorized emergency vehicle. The purpose should include the nature and scope of the duties, responsibilities, and intended uses of emergency equipment, as well as the statutes that give authority for the listed equipment and uses. Premier Motor Escort provides motor escort services to local Funeral Directors and Families in a time honored tradition devoted to those that have passed in a procession of their loved ones to the place of internment while keeping the safety of the procession and general public at the forefront. Authority: RCW 46.37.194 WAC Chapter 204-36 WAC 308-330-466 WAC 204-36-050(3) 3000-323-006(R 8115) Page 1 of 7 AUTHORIZED EMERGENCY VEHICLE PERMIT �°°�r"s'"waax�Ncxcrr:rare r•a.ao: 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 2012 7G8660 SIREN WHELEN PA112 MAKE MODEL ® LAMP(S) (location/colors) f HONDA ST1300P FRONT- REDfCLEAR WHELEN kOO+LINZ6 VIN SIDES - RED CLEAR WHELEN 00+LINZ6 JH2SC513XCK000014 REAR - RED WHELEN 500+LINZ6+TIR3 REGISTERED OWNER ® OTHER EQUIPMENT: REAR LGHTBAR WHELEN ID4RRRR red THOMAS P DEBARTOLO VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2009 5F4039 ® SIREN WHELEN _WPA112 MAKE MODEL ® LAMP(S) (location/colors) ,J HONDA ST1300P FRONT- RED/CLEAR WHELEN 00+LINZ6 2• VIN SIDES - RED/CLEAR_ WHELEN 00+LINZ6 JH2SC51769K600684 _ REAR - RED WHELEN 500+LINZ6+TIR3 REGISTERED OWNER ® OTHER EQUIPMENT: REAR LGHTBAR WHELEN_ !D4RRRR (red) THOMAS P DEBARTOLO CLEAR STROBE 3M OPTICOM 792H VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED _ MAKE MODEL 2006 OG1243 _® SIREN WHELEN WPA112 MAKE MODEL ® LAMP(S) (location/colors) HONDA ST1300P FRONT- RED CLEAR WHELEN O+LINZ6 3• VIN SIDES - RED CLEAR WHELEN 500+LINZ6 JH2SC51716M400294 REAR - RED WHELEN 500+LINZ6+TIR3 REGISTERED OWNER ® OTHER EQUIPMENT: REAR LGHTBAR WHELEN D4RRRR red THOMAS P DEBARTOLO CLEAR STROBE NOVA JCPIE VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 1999 41`4096 ® SIREN WHELEN PA112 MAKE MODEL ® LAMP(S) (location/colors) KAWASAKI KZ1000P FRONT- RED/CLEAR WHELEN 200+TIR6 4• VIN SIDES - RED CLEAR WHELEN OO+TIR6 JKAKZCPP25XB517259 REAR - RED WHELEN 500 REGISTERED OWNER ® OTHER EQUIPMENT: a REAR LGHTBAR WHELEN 1D4RRRR red THOMAS P DEBARTOLO Note: This page may be copied if additional vehicles need to be added to the permit. Any additional sheets attached must provide the vehicle and equipment information in the same format as above. 3000-323-006(R 6/15) Page 2 of 7 AUTHORIZED EMERGENCY VEHICLE PERMIT r ralxj WAUl�19916N UATE"I KOL APPLICATION uOr., 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 9.16590 _SIREN WHELEN - PA112 MAKE MODEL 7 -® LAMP(S) (location/colors) HONDA ST1300 FRONT- RED/WHT WHELEN X TIR3, 1X ION 5• VIN STOBE - CLEAR NOVA CPE 4�ta JH2SC51749K600621 SIDE - RED/WHT WHELEN 2X500SERIES LINZ6 REGISTERED OWNER OTHER EQUIPMENT: REAR LIGHTBAR-RED WHELEN !DOMINATOR 4RARA TIMOTHY HAUN I TRUNK LETS-RED/WHT WHELEN/ABRAMS l2X TIR3/2X E-D300 VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2017 7E8101 ® SIREN WHELEN 15D21OR MAKE MODEL ® LAMP(S) (location/colors) HD FLHTP FRONT- RED/CLEAR WHELEN �_00+UN3 INZ6 ARRAY J 6- VIN SIDES - RED/CLEAR WHELEN 1HDlFMClXHB655974 REAR - RED WHELEN 500 REGISTERED OWNER ® OTHER EQUIPMENT: CLEAR STROBE NOVA _rE�E JOHN HYBRIDGE VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2013 1.11285 SIREN WHELEN PA112 MAKE MODEL LAMP(S) (location/colors) CANAM SPYDER FRONT- RED/CLEAR WHELEN ENFORCER/FLEX 7• VIN SIDES - RED CLEAR WHELEN ENFORCER 2BXNCBC14DVO02916 REAR - RED WHELEN ENFORCER REGISTERED OWNER ® OTHER EQUIPMENT: VERN EARL JOHNSON JR VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED_ MAKE MODEL 2009 3J1257 _ SIREN CODE 3 JR120ORT-P MAKE MODEL ® LAMP(S) (location/colors) J BMW R1200 FRONT- RED TSX3 LED X $• VIN SIDES - RED/WHITE CODE 3 TD901 WB10388029ZT15446 ,REAR - RED CODE 3 TSX3 REGISTERED OWNER ® OTHER EQUIPMENT: REAR POLE LIGHT REDTRONIC IEM03 THOMAS P DeBARTOLO Note: This page may be copied if additional vehicles need to be added to the permit. Any additional sheets attached must provide the vehicle and equipment information in the same format as above. 3000-323-006(R 6/15) Page 3 of 7 AUTHORIZED EMERGENCY VEHICLE PERMIT '''!11. APPLICATION l;�I �P' 2. Vehicle Information: List all vehicles intended to be used as authorized emergency vehicles. For each vehicle, provide all vehicle and emergency equipment information as outlined below. Prior approval must be given before utilizing a new vehicle or a vehicle with equipment installed other than what is authorized under the current permit for that vehicle. Proof of insurance for each vehicle must be attached pursuant to WAC 204-36-030. If providing funeral escorts, proof of commercial insurance in Washington State or business use exemption must be provided pursuant to WAC 204-36-040. VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2006 4D9116 ® SIREN WHELEN �WPA112 MAKE MODEL ® LAMP(S) (location/colors) HONDA ST1300P FRONT- RED CLEAR WHELEN OO+LINZ6 9• VIN SIDES - RI"E3JCLEAR WHELEN 00+LINZ6 JH2SC51706M400268 REAR - RED WHELEN 500+LINZ6+TIR3 REGISTERED OWNER ® OTHER EQUIPMENT: REAR LIGHTBAR WHELEN D4RRRR THOMAS P DeBARTOLO VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ❑ SIREN MAKE MODEL ❑ LAMP(S) (location/colors) 10. VIN REGISTERED OWNER ❑ OTHER EQUIPMENT: VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL SIREN MAKE MODEL ❑ LAMP(S) (location/colors) 11• VIN REGISTERED OWNER ❑ OTHER EQUIPMENT: VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ❑ SIREN MAKE MODEL ❑ LAMP(S) (location/colors) 12• VIN REGISTERED OWNER ❑ OTHER EQUIPMENT: Note: This page may be copied if additional vehicles need to be added to the permit. Any additional sheets attached must provide the vehicle and equipment information in the same format as above. 3000-323-006(R 6/15) Page 4 of 7 AUTHORIZED EMERGENCY VEHICLE PERMIT "_fS1ING1vN-Si1L YAiRO APPLICATION 3. Operators: Please list all drivers that will be authorized to operate the vehicle(s) listed in this application and indicate whether or not the operator/driver is new since your last application by placing an X in the "New?" column; otherwise, leave this column blank. No drivers should be listed unless they have been approved. Per WAG 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 New? (if applicable—see WAC 204-36-040) THOMAS P. DEBARTOLO WDL45TPG243B 452575 - Expires: 03/2024 ANTHONY J DEBARTOLO WDL426N8253B 8253B- Expires: 09/2026 JOHN HYBRIDGE WDL6361F283B 402583 - Expires 6/2025 VERNON JOHNSON WDL2R8R8483B ES003875 - Expires 5/2025 JULIUS PARNICZKY P652420644260 (FL) 454431- Expires: 05/2024 TWYLA R DEBARTOLO* WDLIB8NGD13B GD12B- Expires: 09/2026 ROBERT SETO WDL6TN83F8SB AT300254 - Expires: 09/2025 J TIMOTHY HAUN WDL5TRT5093B 5270492 - Expires 04/2025 "PROVIDES IRAFFIC CONTROL SERVICES ONLY 3000-323-006(R 6/15) Page 5 of 7 AUTHORIZED EMERGENCY VEHICLE PERMIT � ' SNIY* 1111 MiNM APPLICATION 4. Geographic Area: Indicate which types of roads and which specific geographic area(s) the authorized emergency vehicles will be used. Certification from each jurisdiction is required under WAC 204-36-030. Certification is covered in section 6 of this application. ® City Streets (list all cities) City of Kent ❑ County Roads (list all counties) _ ❑ State Routes/Interstates (list all state routes, interstates, and counties) 5. Permit Validation: I certify (or declare) under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct to the best of my knowledge, information, and belief, and that: a. All of the information given in this application is correct to the best of my knowledge and provided in its full format to the undersigned chief law enforcement officer or fire chief(if the vehicle is to be used for firefighting purposes) of each primary jurisdiction in which the vehicles are to be used as authorized emergency vehicle(s). b. None of the drivers, to the best of my knowledge, in the last year, have been convicted of, nor served any sentences or periods of probation for any felonies, nor arrested and convicted of a drug or alcohol violation or illegal use or possession of drugs, nor been required to register as a sex offender. c. Only the vehicle(s) and equipment listed in this application will be used as outlined in this application, and that only the operators listed under this permit will drive the vehicle(s). As the primary holder or executive officer in charge of overseeing this permit, I understand that if the permit is issued, it is my responsibility to ensure: a. No driver listed in this permit uses the vehicle for any purpose not authorized under this permit unless all emergency equipment is removed or covered. b. No driver other than those listed under this approved permit operates the vehicle(s) listed unless all emergency equipment is removed or covered. If I wish to add a new driver or vehicle to this permit, I must receive prior approval before they are authorized under this permit. c. The driver must exercise due care and caution and must obey all traffic laws. I understand that the inappropriate or misuse of authorized emergency vehicles may result in criminal or civil liability as well as cancellation of this permit as outlined under chapter 204-36 WAC. In addition, I understand that it is my responsibility to ensure that a copy of this permit listing all approved drivers and geographic areas authorized, as well as a copy of the vehicle permit authorizing emergency equipment is present in each vehicle at all times and must be presented to law enforcement, if requested. Signature -'pm DeBartolo Title Owner Premier Motor Escort LLC (CHIEF EXECUTIVE OFFICER) Name Tom DeBartolo _ Date 09/26/2023 (TYPE OR PRINT) 3000-323-006(R 8115) Page 6 of 7 AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION 6. Certification: This application for an Authorized Emergency Vehicle Permit will not be accepted unless CERTIFIED by the chief law enforcement officer or fire chief(if the vehicle is to be used for firefighting purposes)of each primary jurisdiction in which the vehicle(s) are to be used as authorized emergency vehicles(see part 4 of this application). If the application is made by the chief of a law enforcement agency or fire department, it must be CERTIFIED by the head of the political sub-division. The certification must include the following language: "I hereby certify that I have reviewed this entire application; that I am aware that the applicant intends to use the vehicle(s) and emergency equipment listed in part 2 of this application, for the specific purposes listed in part 1 of this application; that a need exists in my jurisdiction for the listed vehicle(s) to be used as authorized emergency vehicles and that the applicant has the appropriate authority as described in part 1 of this application to operate such equipment; and I know of no reason why this application should be denied." Please type or print: J Signature Dat§/d-(v - v� Title div Name (Please Print) - �01 Jurisdiction Afe Phone 5TG . ,�� E-Mail 1111JAPWadl ltti Restrictions Signature Date Title Name (Please Print) _ _ _ Jurisdiction Phone ( ) E-Mail Restrictions Signature Date Title Name (Please Print) Jurisdiction Phone ( ) E-Mail Restrictions Signature Date Title Name (Please Print) Jurisdiction _ Phone ( ) E-Mail Restrictions Signature Date _ Title Name (Please Print) Jurisdiction Phone ( ) _ E-Mail Restrictions Signature Date Title Name (Please Print) Jurisdiction Phone ( ) E-Mail Restrictions Note: This page may be copied if additional certifications need to be added to the permit. Any additional sheets attached must provide the certification information in the same format as above. 3000-323-006(R 8/15) Page 7 of 7