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HomeMy WebLinkAboutAG 18-0641 1 RETURN TO: EXT: CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM ORIGINATING DEPT./DIV: Po ORIGINATING STAFF PERSON: CASO7 cI ort E 3 TYPE OF DOCUMENT (CHECK ONE): ❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ) ❑ PUBLIC WORKS CONTRACT 0 PROFESSIONAL SERVICE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT ❑ REAL ESTATE DOCUMENT 0 ORDINANCE ❑ CONTRACT AMENDMENT (AG#): p OTHER PROJECT NAME: EXT: 6-4- 1-2, 3. DATE REQ �Y: 0 3 • Zo • z o tP O SMALL OR LIMITED PUBLIC WORKS CONTRACT O MAINTENANCE AGREEMENT O HUMAN SERVICES / CDBG O SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) O RESOLUTION ❑ INTERLOCAL NAME OF CONTRACTOR: ?ft c. i Yt- t'A i0(‘- c S cor`41. L- L L ADDRESS: PO Bax SSb3 4, SKoRE LwC wet Y 81Ss - 0 634 TELEPHONE 106 - S42- -'t 63 E-MAIL: fitenisettnvib a ESca (rr Q. cc" cJ1..vr • NET FAX: SIGNATURE NAME: 'To ^n Q GQA(ZibLo TITLE owNC7L EXHIBITS AND ATTACHMENTS: 0 SCOPE, WORK OR SERVICES 0 COMPENSATION 0 INSURANCE REQUIREMENTS/CERTIFICATE,[ALL OTHER REFERENCED EXHIBITS 0 PROOF OF AUTHORITY TO SIGN 0 REQUIRED LICENSES 0 PRIOR CONTRACT/AMENDMENTS TERM: COMMENCEMENT DATE: 8 'U Sf..¢ COMPLETION DATE: ').O\ 1 1)1.242(w TOTAL COMPENSATION $ � (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: 0 YES 0 NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED 0 YES 0 NO IF YES, $ PAID BY: 0 CONTRACTOR 0 CITY RETAINAGE: RETAINAGE AMOUNT: -- 0 RETAINAGE AGREEMENT (SEE CONTRACT) OR 0 RETAINAGE BOND PROVIDE O PURCHASING: PLEASE CHARGE TO: 0. DOCUMENT/CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED ❑ PROJECT MANAGER O DIRECTOR O RISK MANAGEMENT (IF APPLICABLE) ❑ LAW mac. 3 /z!/IS- 1. COUNCIL APPROVAL (IF APPLICABLE) SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE: SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE: 2. CONTRACT SIGNATURE ROUTING O SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D: ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS ❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR 1 MONTH PRIOR TO EXPIRATION DATE (Include dept. support staff if necessary and feel free to set notification more than a month in advance if council approval is needed.) INITIAL / DATE SIGNED O LAW DEPARTMENT SIGNATORY (MAYOR o IREC B) CITY CLERK ❑ ASSIGNED AG# AG# 19 --CAV ❑ SIGNED COPY RETURNED DATE SENT: t/ t lie 0 0- t :OMMENTS: 1001R AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION PATROL WASHINGTON STATE PATROL EQUIPMENT & STANDARDS REVIEW UNIT GENERAL ADMINISTRATION BLDG PO BOX 42600 OLYMPIA WA 98504-2600 DATE APPROVED: VALID UNTIL: CAPTAIN: For De•artment Use Onl 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 98155-0634 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. We provide motor escort services to local Funeral Directors and Families in a time honored tradition devoted to those that have passed in a procession of their loved ones to the place of internment while keeping the safety of the procession and general public at the forefront. RCW 46.37.194 Chapter 204-36 WAC WAC 308-330-466 WAC 204-36-050(3) 3000-323-006 (R 8/15( Page 1 of 6 AUTHORIZED EMERGENCY VEHICLE PERMIT 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 YEAR LICENSE NO. 2006 4D9116 MAKE MODEL Honda STI300EX 1. VIN JH2SC51706M400268 REGISTERED OWNER DeBartolo, Thomas P VEHICLE INFORMATION 2. YEAR LICENSE NO. 2017 9208LEM MAKE MODEL H -D FLHTP VIN I H D I FMC 13 H 8643262 REGISTERED OWNER Pamiczky, Julius VEHICLE INFORMATION 3.VIN YEAR LICENSE NO. 2017 7E8101 MAKE MODEL H -D FLHTP I HD I FMC I XHB655974 REGISTERED OWNER Hybridge, John VEHICLE INFORMATION 4. YEAR LICENSE NO. 2000 2D8902 MAKE MODEL Kawasaki KZI000 VIN JKAKZCP24YB518386 REGISTERED OWNER Nishiyori, Kenneth W. EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL ® SIREN_ Whelen ® LAMP(S) (location/colors) Front: Red/Clear Whelen Sides: Red/Clear Whelen ® OTHER EQUIPMENT: Rear: Red/Clear Whelen Clear Strobe 3M Opticom 1WPA112 00 +LINZ6 1500 + LINZ6 TIR3 + p4RRRR 792H EMERGENCY EQUIPMENT INSTALLED MAKE INFORMATION MODEL ® SIREN Whelen ® LAMP(S) (location/colors) Front: Red/Clear Whelen Sides: Red/Clear Whelen ® OTHER EQUIPMENT: Rear: Red/Clear Whelen Clear Strobe Nova IWPA 1 12 500 500 + LIN3 500 CPE EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL ® SIREN Whelen ® LAMP(S) (location/colors) Front: Red/Clear Whelen Sides: Red/Clear Whelen ❑ OTHER EQUIPMENT: Rear: Red/Clear Whelen 1.SD2IOR LINZ6 Array 500 + LIN3 500 EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL ® SIREN Fennix ® LAMP(S) (location/colors) Front: Red/Clear Whelen Sides: Red/Clear Whelen ® OTHER EQUIPMENT: Rear: Red/Clear Whelen Storm Pro Note: This page may be copied if additional vehicles need to be added to the permit. Any additional sheets attached must provide the vehicle and equipment information in the same format as above. 3000-323-006 (R 8/15) Page 2 of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT 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 YEAR LICENSE NO. 12017 9016LEM MAKE MODEL H -D FLHTP 1•1VIN i IHDIFMCI3HB643830 REGISTERED OWNER Radford, Earl Stanley Jr VEHICLE INFORMATION YEAR LICENSE NO. 2005 6C429I MAKE MODEL BMW RII5ORT 2., VIN WB 10499A85ZE96222 REGISTERED OWNER Royer, Serge F.E VEHICLE INFORMATION 3. YEAR LICENSE NO. 2006 1F4256 MAKE MODEL Honda ST1300 VIN J H2SC51716 M400294 REGISTERED OWNER Kringle, David S. VEHICLE INFORMATION 'YEAR MAKE MODEL 4.'VIN REGISTERED OWNER LICENSE NO. EMERGENCY EQUIPMENT INSTALLED MAKE INFORMATION MODEL ® SIREN Whelen LAMP(S) (location/colors) Front: Red/Clear Whelen Sides: Red/Clear Whelen 1WSSPA30 L1NZ6 Array INZ6 ❑ OTHER EQUIPMENT: Rear: Red/Clear Whelen 1LINZ6 EMERGENCY EQUIPMENT INSTALLED MAKE INFORMATION MODEL ® SIREN Code 3 ® LAMP(S) (location/colors) Front: Red/Clear Code 3 Sides: Red/Amber Code 3 ❑ OTHER EQUIPMENT: Rear: Red/Clear Code 3 13950 IPSELEDF 12 PSELEDF12 SELEDFl2 EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL ® SIREN Whelen LAMP(S) (location/colors) Front: Red/Clear Whelen Sides: Red/Clear Whelen ® OTHER EQUIPMENT: Rear: Red/Clear Whelen Clear Strobe 3M 1SA314 LINZ6 Array TIRE TIR3 + D4RRRR Opticom EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL ❑ SIREN ❑ LAMP(S) (location/colors) ❑ 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 8/15) Page 2 of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION 3. Operators: Please list all drivers that will be authorized to operate the vehicle(s) listed in this application and indicate whether or not the operator/driver is new since your last application by placing an X in the "New?" column; otherwise, leave this column blank. No drivers should be listed unless they have been approved. Per WAC 204-36-040, all operators involved in traffic control must be a Washington State certified flagger, and carry their certified flagger card at all times. Name Driver's License Number Flagger Certification Number (if applicable — see WAC 204-36-040) New? Thomas P DeBartolo DEBARTP395B8 395615 - Expires: 02/2021 Twyla R DeBartolo DEBARTR389BJ 377616 - Expires: 01/2020 Anthony J DeBartolo DEBARAJ097OE 389487 - Expires: 09/2020 Julius E Parniczky PARNIJ*363Q6 334190 - Expires: 04/2018 John Hybridge HYBRIJ*528JG 360390 - Expires: 05/2019 Kenneth W Nishiyori NISHIKW377JA 334246 - Expires: 03/2020 Earl Stanley Radford Jr RADFOES465RT 374214 - Expires: 05/2019 Serge FE Royer ROYERSF419DP 346608 - Expires: 04/2020 David Scott Kringle KRINGDS397RH 389969 - Expires: 08/2020 3000-323-006 (R 8/15) Page 3 of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT 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) Algona, Auburn, Bainbridge Island, Bellevue, Black Diamond, Bonney Lake, Bothell, Bremerton, Brier, Buckley, Burien, Carnation, Cle Elum, Covington, Des Moines, DuPont, Duvall, Edgewood, Edmonds, Ellensburg, Enumclaw, Everett, Federal Way, Fife, Gig Harbor, Issaquah, Kenmore, Kent, Kirkland, Lacey, Lake Forest Park, Lakewood, Lynnwood, Maple Valley, Marysville, Medina, Mercer Island, Mill Creek, Milton, Monroe, Mountlake Terrace, Mukilteo, Newcastle, Normandy Park, Olympia, Orting, Pacific, Port of Seattle, Port of Tacoma, Poulsbo, Puyallup, Redmond, Renton, Roy, Sammamish, Seatac, Seattle, Shoreline, Snohomish, Snoqualmie/North Bend, Sumner, Tacoma, Tukwila, University Place, Woodinville. 5. Permit Validation: 1 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, 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 tirues-a rust be presented to law enforcement, if requested. Signature (CHIEF EXECUTIVE OFFICER) Title Owner, Premier Motor Escort, LLC Name Tom DeBarto o Date 02/23/2018 (TYPE OR PRINT) 3000-323-006 (R 8115) Page 4 of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT •,W 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 f or fire department, it must be CERTIFIED by the head of the political sub -division. The certification must S include the following language: "I hereby certify that I have reviewed this entire application; that I am aware that the applicant intends to use :•:the vehicle(s) and emergency equipment listed in part 2 of this application, for the specific purposes listed in • : • part 1 of this application; that a need exists in my jurisdiction for the listed vehicle(s) to be used as • :authorized emergency vehicles and that the applicant has the appropriate authority as described in part 1 of •;•this application to operate such equipment; and I know of no reason why this application should be denied." Please type or print: Signature 4.4 7: 1 4 /4^'t Date ‘s2/1? Title ea .4 Sway /444 -iv Jurisdiction ryvC�,eiye..., w,d., Phone ( Ci) &3S"-6714 E -Mail 4.44. k4.•a..c9 a c:17•4401.44..../..) Ay. Co Restrictions Name (Please Print) Signature Date Title Name (Please Print) Jurisdiction Phone ( ) E -Mail Restrictions Signature Date Title Name Jurisdiction (Please Print) Phone ( ) E -Mail Restrictions Signature Date Title Name (Please Prtnt) Jurisdiction Phone ( ) E -Mail Restrictions Signature Date Title Name (Please Prot) 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 5 of 5 Casey Jones From: PremierMotorEscort <PremierMotorEscort@comcast.net> Sent: Tuesday, April 03, 2018 13:19 To: Casey Jones Subject: Re: FW: PME AEV Permit Request Yes, Premier Motor Escort will make every effort to notify the Federal Way Police Department prior to funeral escorts through tour jurisdiction. Thank you for your assistance, Tom DeBartolo Owner Premier Motor Escort Original message From: Casey Jones <Casey.Jones@cityoffederalway.com> Date: 4/3/18 1:10 PM (GMT -08:00) To: "'PremierMotorEscort@comcast.net'" <PremierMotorEscort@comcast.net> Subject: FW: PME AEV Permit Request Would you confirm that your company will make attempts to give advanced notice to the city of Federal Way Police Department when you have reasonable, advanced notice of escorts that will be coming through or to our city. We understand that your escort schedule can be somewhat unpredictable and at time is subjected to last minute requests by your customers. Notice can be sent to me at casey.jones@cityoffederalway.com or to the traffic lieutenant at Brigham.Schulz@cityoffederalway.com Thanks, Casey Jones, Commander 253-835-6713 From: Stephan Neal Sent: Wednesday, March 14, 2018 12:52 To: Casey Jones Subject: FW: PME AEV Permit Request Importance: High 1 Please review and provide a response Steve Neal Deputy Chief of Police Federal Way Police Department Stephan.Neal@cityoffederalway.com 253.835.6717 From: PME[mailto:PremierMotorEscort@acomcast.net] Sent: Wednesday, March 14, 2018 12:38 PM To: Stephan Neal Cc: Lynette Allen Subject: PME AEV Permit Request Importance: High PREMIER MOTOR ESCORT, LLC. "Safe Passage for You and Yours" Chief Andy Hwang City of Federal Way Police Department Dear Chief Hwang, 2 February 23, 2018 Once again Premier Motor Escort is requesting permission to escort funeral processions in and through your jurisdiction. Washington State Patrol requires that we renew our Authorized Emergency Vehicle Permit each year. Please sign page 5 for your jurisdiction, and return via e-mail. Our vehicles aide funeral directors and represented families, by honoring a long held tradition devoted to those that have passed, escorting loved ones to their final place of internment. Freeway travel will be limited and used only as a last resort. All Premier Motor Escort officers have passed background checks by the FBI and WSP. Their motorcycles are Authorized Emergency Vehicles certified through the Washington State Patrol. Our team consists of active and retired police officers, firefighters, military and properly trained civilians. Safety being a high priority, we have active and retired police officers that assist in continuous proficiency training of our riders, as well as the ever changing requirements identified in RCW's and WAC's. Facilitating the needs of the bereaved and their families, while maintaining a safe, structured, transition to the place of internment, is the primary duty of all our officers. Thank you for considering our request. We look forward to continuing to work with you. Respectfully, Tom DeBartolo Owner Premier Motor Escort, LLC. PO Box 55634 Shoreline, WA 98155-0634 Email: PremierMotorEscort@comcast.net Website: www.PremierMotorEscort.com Office: 206-542-4763 3 Cell: 206-349-3321 4 Casey Jones From: Stephan Neal Sent: Wednesday, March 14, 2018 12:52 To: Casey Jones Subject: FW: PME AEV Permit Request Attachments: PME AEV Permit REQUEST Cities.pdf Importance: High Please review and provide a response Steve Neal Deputy Chief of Police Federal Way Police Department Stephan.Neal@cityoffederalway.com 253.835.6717 From: PME[mailto:PremierMotorEscort@comcast.net] Sent: Wednesday, March 14, 2018 12:38 PM To: Stephan Neal Cc: Lynette Allen Subject: PME AEV Permit Request Importance: High PREMIER MOTOR ESCORT, LLC. "Safe Passage for You and Yours" February 23, 2018 Chief Andy Hwang City of Federal Way Police Department Dear Chief Hwang, Once again Premier Motor Escort is requesting permission to escort funeral processions in and through your jurisdiction. Washington State Patrol requires that we renew our Authorized Emergency Vehicle Permit each year. Please sign page 5 for your jurisdiction, and return via e-mail. Our vehicles aide funeral directors and represented families, by honoring a long held tradition devoted to those that have passed, escorting loved ones to their final place of internment. Freeway travel will be limited and used only as a last resort. All Premier Motor Escort officers have passed background checks by the FBI and WSP. Their motorcycles are Authorized Emergency Vehicles certified through the Washington State Patrol. Our team consists of active and retired police officers, firefighters, military and properly trained civilians. Safety being a high priority, we have active and retired police officers that assist in continuous proficiency training of our riders, as well as the ever changing requirements identified in RCW's and WAC's. 1 Facilitating the needs of the bereaved and their families, while maintaining a safe, structured, transition to the place of internment, is the primary duty of all our officers. Thank you for considering our request. We look forward to continuing to work with you. Respectfully, Tom DeBartolo Owner Premier Motor Escort, LLC. PO Box 55634 Shoreline, WA 98155-0634 Email: PremierMotorEscort@comcast.net Website: www.PremierMotorEscort.com Office: 206-542-4763 Cell: 206-349-3321 2