AG 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