HomeMy WebLinkAboutCal OES Governor's Office of Emergency Services - 2019-08-06 GAVIN NEWSOM MARK S.GHILARDUCCI
GOVERNOR Cal "r S DIRECTOR
E.
OOVERNOR'S OFFICE
OF EMERGENCY SERVICES
July 26, 2019
David Segura Fire Chief
Huntington Beach Fire Department
2000 Main St. — 5th Floor
Huntington Beach, CA 92648
Dear Chief Segura:
You will find enclosed two copies of Assignment of Equipment Form, and Agreement for
Temporary Transfer of Vehicular Equipment covering the assignment of Cal OES Fire Engine
No. 416 to the Huntington Beach Fire Department. The Agreement is effective August 6th, 2019.
Please have the authorized official sign both copies of the above-mentioned documents and
return one original set to our office.
NOTE 1: Cal OES cannot assign the apparatus to your agency until this signed Agreement is
returned.
It is required that this office be furnished with a Certificate of Insurance, or a letter certifying
self-insurance in accordance with Paragraph 16 and 17 of the Agreement for Temporary Transfer
of Vehicular Equipment.
If you have any questions regarding this assignment, please feel free to contact our office.
Sincerely,
BRIAN S MARSHALL
State Fire and Rescue Chief
BSM/RO-s CA:) :j
Enclosures
Cc: Daryl L. Osby, Region I Fire and Rescue Coordinator
Brian Fennessy, Orange Operational Area Coordinator
Art Torrez, Cal OES Deputy Chief of Operations
John Salvate, Cal OES Assistant Chief
Dave Stone, Cal OES Assistant Chief
3650 SCHRIEVER AVENUE • MATHER,CA 95655
FIRE AND RESCUE DIVISION
PHONE: (916)845-8711 • FAX: (916)845-8396
GAVIN NEWSOM MARK S.GHILARDUCCI
GOVERNOR Cal 1Es DIRECTOR
GOVERNOR'S OFFICE
OF EMERGENCY SERVICES
July 26, 2019
David Segura Fire Chief
Huntington Beach Fire Department
2000 Main St. —51h Floor
Huntington Beach, CA 92648
Dear Chief Segura:
You will find enclosed two copies of Assignment of Equipment Form, and Agreement for
Temporary Transfer of Vehicular Equipment covering the assignment of Cal OES Fire Engine
No. 416 to the Huntington Beach Fire Department. The Agreement is effective August 61h, 2019.
Please have the authorized official sign both copies of the above-mentioned documents and
return one original set to our office.
NOTE 1: Cal OES cannot assign the apparatus to your agency until this signed Agreement is
returned.
It is required that this office be furnished with a Certificate of Insurance, or a letter certifying
self-insurance in accordance with Paragraph 16 and 17 of the Agreement for Temporary Transfer
of Vehicular Equipment.
If you have any questions regarding this assignment, please feel free to contact our office.
Sincerely,
BRAIN S MARSHALL
State Fire and Rescue Chief
BSM/RO-s
Enclosures
Cc: Daryl L. Osby, Region I Fire and Rescue Coordinator
Brian Fennessy, Orange Operational Area Coordinator
Art Torrez, Cal OES Deputy Chief of Operations
John Salvate, Cal OES Assistant Chief
Dave Stone, Cal OES Assistant Chief
3650 SCHRIEVER AVENUE • MATHER,CA 95655
FIRE AND RESCUE DIVISION
PHONE: (916)845-8711 • FAX: (916)845-8396
State of California
GOVERNOR'S OFFICE OF EMERGENCY SERVICES
Fire and Rescue Division
AGREEMENT FOR
TEMPORARY ASSIGNMENT OF VEHICULAR EQUIPMENT
THIS AGREEMENT, entered into this 6th day of August, 2019, by and between the Governor's
Office of Emergency Services, hereinafter "CAL OES" acting by and between its duly
appointed and qualified Director of the Governor's Office of Emergency Services and the
Huntington Beach Fire Department acting by and through its duly appointed, qualified and acting
officers, hereinafter called "ASSIGNEE."
WITNESSETH:
WHEREAS, the State of California has purchased fire apparatus and equipment for the purpose
of responding to incidents in furtherance of the California Fire Service and Rescue Emergency
Mutual Aid Plan; and
WHEREAS, Cal OES is authorized to assign these fire apparatus and equipment to local
jurisdictions throughout the State under written agreements to be staged for Cal OES purposes
and for use by local jurisdictions for the purposes described below; now, therefore,
IT IS HEREBY MUTUALLY AGREED between the parties hereto as follows:
1. ASSIGNMENT. CAL OES hereby transfers possession to ASSIGNEE and ASSIGNEE
hereby accepts possession from CAL OES of the fire apparatus and equipment listed on the
attached Exhibit "A" which is by this reference made a part hereof, for the period commencing
August 6th, 2019, for the following all-risk events, emergency incidents, civil defense and
disaster purposes, namely:
Mutual aid, multiple alarm events and emergency incidents, emergency incidents
threatening properties vital to national defense or important military installations,
parades and displays, training of regular, volunteer and auxiliary firefighters and
temporary standby for ASSIGNEE's regular apparatus and the regular apparatus
of other departments while out of service for repairs.
a. Vehicle Description: 2019 HME Type I Engine
Vehicle Designation: 416
Vehicle License Number: 1562260
Vehicle Identification Number: 44KFT428 I KWZ23237
Value of Vehicle: $379,598.53
Value of Hose and Appliances: $38,000.00
b. Equipment inventories (Exhibit "A") may by mutual concurrence of the CAL
OES and ASSIGNEE be changed during the term of this Agreement, utilizing property
accountability procedures established or approved by the State.
2. TERM. The term of this Agreement shall be for ten (10) years unless terminated pursuant
to the terms of this Agreement.
3. CONSIDERATION. Consideration for this Agreement is the mutual benefit the parties will
enjoy by having a fire apparatus locally available for use as provided in this Agreement.
1 04/2012
Agreement for Temporary Assignment of Vehicular Equipment
State of California
GOVERNOR'S OFFICE OF EMERGENCY SERVICES
Fire and Rescue Division
4. HouSING, MAINTENANCE, REPAIR, AND REPLACEMENT. During the term of this transfer,
ASSIGNEE agrees to adequately house in an enclosed secure structure, staff, operate, maintain
and repair(consistent with section 4b) said fire apparatus and equipment (hereinafter collectively
referred to as "the Apparatus" except where it is desired to refer to equipment alone, in which
case the term "Equipment" is used) at its sole cost and expense, except as otherwise expressly
provided in this Agreement. ASSIGNEE also agrees to complete all reports and maintain
records consistent with Section 14. Apparatus shall be housed on property of the ASSIGNEE in
a manner to provide reasonable protection against inclement weather, sabotage, theft, or
malicious damage. Apparatus shall be maintained in such condition that it is available for
immediate emergency use, and at the same standard as other emergency apparatus operated by
ASSIGNEE. Maintenance shall include care of hose, batteries, tires, appliances, lubrication and
fuel, general cleaning and polishing, minor body repairs and periodic testing. Repairs shall
include, without being limited to, motor tune-ups, pump repairs, transmission, differential and all
running gear, brake and exhaust systems, cooling devices including radiator, pump packing, and
equipment assigned to Apparatus.
a. Repairs to the extent of $100.00 for each individual item of repair shall be the
responsibility of ASSIGNEE.
b. Repairs to the extent that they exceed $100.00 for each individual item of repair
shall be the responsibility of CAL OES on a $100.00 deductible basis, unless in the judgment of
the CAL OES the need for repair results from misuse or negligence on the part of ASSIGNEE
in the maintenance or use of the Apparatus, in which event the cost of each such item of repair
above $100.00 shall also be the responsibility of ASSIGNEE. In no event shall ASSIGNEE
arrange for repairs costing over $100.06 for any item of repair, whether it is the responsibility of
CAL OES or ASSIGNEE, without first obtaining written authorization from the Cal OES Fire
and Rescue Division.
C. Notwithstanding the foregoing, replacement of hose, batteries and tires shall be
the responsibility of CAL OES, except to the extent CAL OES determines that the damage
thereto is the result of negligence or misuse on the part of ASSIGNEE, in which event
ASSIGNEE will bear such portion of the replacement cost thereof as the CAL OES deems
equitable. Procurement of tires, hose and batteries is subject to State fiscal policies and
procedures, and written approval must be obtained from the Cal OES Fire and Rescue Division
prior to procurement.
d. Maintenance and repairs must be requested and authorized pursuant to the most
recent version of the Cal OES Fire and Rescue Division Operations Bulletin #18, which is
hereby incorporated into this Agreement by reference.
e. Repair or replacement of the Apparatus transferred hereunder which is consumed,
lost, stolen, damaged or destroyed during mutual aid operations when CAL OES has dispatched
or directed the dispatch of said Apparatus through Regional or Operational Area Fire and Rescue
Coordinators, or when CAL OES has reassigned said Apparatus pursuant to the provisions of
paragraph 11 of this Agreement, shall be the responsibility of CAL OES, providing that any
such loss or damage shall be the responsibility of ASSIGNEE, if due to the negligence of
ASSIGNEE. ASSIGNEE agrees that it will assume responsibility in full for the repair or
replacement of Apparatus that has been consumed, lost, stolen, damaged or destroyed in
2 04/2012
Agreement for Temporary Assignment of Vehicular Equipment
State of California
GOVERNOR'S OFFICE OF EMERGENCY SERVICES
Fire and Rescue Division
operations ASSIGNEE has directed or controlled.
f. ASSIGNEE must request from CAL OES, in writing, permission to make any
and all changes to assigned fire apparatus and equipment. Furthermore, ASSIGNEE will not
make modifications, changes, adjustments, or additions, including decals or stickers, to
Apparatus without prior written approval from CAL OES.
5. INSPECTION OF APPARATUS. ASSIGNEE agrees that representatives of the Cal OES Fire
and Rescue Division and other authorized State personnel may inspect the Apparatus at any time.
6. STAFFING. Reasonable and continual training shall be carried on so that trained personnel
shall at all times be available to staff and operate said Apparatus. The ASSIGNEE shall provide
personnel to staff the assigned apparatus per FIRESCOPE ICS standards. The Cal OES engine
may be assigned to out of area assignments for up to 14 days, plus travel time. When local
government personnel, staffing Cal OES Apparatus, are committed to extended assignments
there may be a need to replace or rotate personnel. Personnel rotation will follow the direction
outlined in the California Fire Assistance Agreement when assigned to an incident within
California. Crew rotation for incidents outside of California shall be consistent with the
appropriate forest's agencies policy and coordinated by Cal OES.
7. PERSONAL PROTECTIVE EQUIPMENT (PPE) AND SPECIALIZED EQUIPMENT. In addition to
providing the standard complement of firefighting PPE, it shall be the ASSIGNEE'S
responsibility to provide its personnel with all other PPE that may be required by NFPA 1901,
other NFPA Standards, and California Title 8. This shall include, but not be limited to, one
Traffic Vest (ANSI / ISEA 207) for each seating position. In addition, we recommend chainsaw
chaps be provided. In addition, an automatic external defibrillator (AED) has been added to
"Miscellaneous Equipment" in NFPA 1901. To provide consistency with the ASSIGNEE'S
equipment, it shall be the ASSIGNEE'S responsibility to provide this device for use on the
assigned engine.
8. TRAINING. Personnel assigned shall meet wildland fire and ICS standards established in
the California Incident Command Certification System (CICCS) or NWCG 310-1, Wildlife
Qualification System Guide (current edition). Personnel assigned to Cal OES Engine's shall
meet Rescue System I standards as certified by the California State Fire Marshal, or have
completed an equivalent course that meets or exceeds Rescue System I curriculum.
9. DISPATCHING. All movement of the Apparatus shall be handled through the official
dispatching channels of ASSIGNEE. ASSIGNEE dispatchers will recognize and act on all
official requests for movement of the Apparatus in conformance with the Fire and Rescue Annex
(California Fire and Rescue Mutual Aid System) to the State Emergency Plan and its subsequent
revisions. CAL OES reserves the right to dispatch, direct the dispatch of, or temporarily
reassign the Apparatus whenever, in the opinion of the Director of Cal OES, his representatives
or Operational Area and Regional Fire and Rescue Coordinators, such Apparatus is essential to
the protection of life and property in another jurisdiction or in the best interest of the State.
10. MUTUAL AID RESPONSE. Procedures for mutual aid response shall be in accordance with
California Fire Service and Rescue Emergency Mutual Aid Plan.
11. REIMBURSABLE RESPONSE. Reimbursement for mutual aid may be provided pursuant to a
3 04/2012
Agreement for Temporary Assignment of Vehicular Equipment
State of California
GOVERNOR'S OFFICE OF EMERGENCY SERVICES
Fire and Rescue Division
governor's disaster proclamation or when conditions warrant invoking the California Fire
Assistance Agreement, the State of Nevada Cooperative Agreement, or the Interstate Compact as
appropriate. There is no other existing provision for mutual aid reimbursement.
12. TEMPORARY USE. ASSIGNEE shall be permitted to use the Apparatus for temporary
cover of fire stations when emergency conditions warrant, or when regular apparatus is out of
service for repairs and a closer engine cannot cover the gap. In either case, the ASSIGNEE shall
immediately notify the Operational Area Dispatch Center and the Cal OES Fire Duty Chief. The
ASSIGNEE further agrees that Cover-in or Standby of said Apparatus exceeding 30 days is at
the discretion of the CAL OES.
13. TEMPORARY TRANSFER.
a. A sub-assignment of the Apparatus or any portion thereof by ASSIGNEE for any
period not exceeding seven consecutive days within a given Operational Area may be made with
the consent of the Operational Area Fire and Rescue Coordinator and the CAL OES, providing
that at the time such Apparatus is received, such Sub-Assignee furnish ASSIGNEE and CAL
OES a letter to the effect that he assumes all obligations of ASSIGNEE with respect to such
Apparatus under this Agreement during the period of assignment, including insurance coverage
in accordance with Section 16 or 17, as appropriate. Any sub-assignment by ASSIGNEE for a
period of more than seven consecutive days shall be subject to authorization by the CAL OES
and execution of an "Agreement for the Temporary Transfer of Vehicular Equipment," with the
agency requesting the transfer.
b. Whenever Apparatus is assigned in accordance with the provisions of this
paragraph, regular ASSIGNEE shall be relieved of its obligations under this Agreement during
such period of sub-assignment.
C. Complete a written Temporary Cal OES Apparatus Assignment Record, Exhibit
"B". The ASSIGNEE will retain one copy, the Sub-Assignee will retain one copy, and one copy
will be forwarded to the Cal OES Fire and Rescue Division.
14. REPORTS AND RECORDS. ASSIGNEE shall maintain daily and monthly reports on the
details of Apparatus use on Cal OES F-101 Form. A Smoke Opacity Test, Pump Test, Hose
Test, and Ladder Test shall be the responsibility of ASSIGNEE and completed annually.
Written results of all tests and reports shall be forwarded to the Cal OES Fire and Rescue
Division by the end of the calendar year. A recent copy of the tests and reports shall be
maintained in the vehicle logbook.
15. REPORT OF ACCIDENTS. ASSIGNEE shall immediately notify the Cal OES Fire and
Rescue Division following any and all accidents involving the Apparatus. It shall be the
responsibility of ASSIGNEE to fill out State Form 270, "Report of Automobile Accident," and
file the report with the Governor's Office of Emergency Services. A copy of this report shall be
retained by the ASSIGNEE and the original and four copies forwarded to Cal OES.
16. INSURANCE PROTECTION. (Non- State Agencies)
a. ASSIGNEE agrees forthwith to furnish evidence of insurance protecting the legal
liability of the ASSIGNEE and CAL OES for liability and/or property damage with a combined
4 04/2012
Agreement for Temporary Assignment of Vehicular Equipment
State of California
GOVERNOR'S OFFICE OF EMERGENCY SERVICES
Fire and Rescue Division
single limit of$1,000,000.00 per occurrence, by means of a Certificate of Insurance naming the
State of California as Additional Insured. Said certificate shall contain an Agreement by the
insurance company that it will not cancel said policy without 15 days prior written notice to the
CAL OES and that the CAL OES is not liable for the payment of any premiums or assessments
thereon. Said certificate must include the description of the apparatus including VIN, state
license number, and Cal OES unit number.
b. In the event the ASSIGNEE is self-insured, ASSIGNEE in lieu of a certificate of
insurance shall furnish CAL OES a written statement of such fact. In such event, ASSIGNEE
agrees to hold the CAL OES harmless from any personal injury or property damage claims
arising out of its maintenance, use or operation of the Apparatus under the terms of this
Agreement.
C. Physical damage insurance, including collision coverage and comprehensive
coverage, shall be obtained. The State of California will be named as a loss payee. In the event
of a non-total loss, ASSIGNEE is responsible for returning Apparatus to original standard. The
description of the vehicle and the necessary amount of insurance required is outlined in attached
Exhibit "C" which is by this reference made a part hereof.
17. INSURANCE PROTECTION. (State Agencies) Any insurance necessary for coverage of the
apparatus shall be the sole responsibility of the department having custody of the vehicle,
including when it directs, dispatches, and controls the use of the Apparatus. ASSIGNEE agrees
to report Apparatus as being under its control to the Insurance Officer, Department of General
Services.
18. TERMINATION OF AGREEMENT.
a. Either party may terminate this Agreement upon 14 days written notice to other
party, or ASSIGNEE may relinquish or CAL OES may repossess any portion of the Apparatus
upon like notice to the other party, except that CAL OES may repossess any portion thereof
without written notice whenever it deems the same is not being maintained in accordance with
this Agreement.
b. Upon the termination of this Agreement, ASSIGNEE agrees to return said
Apparatus in the same condition as received, reasonable wear and tear, acts of God, and
conditions over which it has no control excepted.
C. As inventory changes occur, or items of equipment are replaced, deleted or added
by the CAL OES or replaced by ASSIGNEE, it is mutually agreed that no amendment to this
Agreement need be made at the time of the change; provided however, at the termination of this
Agreement a complete reconciliation of all equipment will be made. ASSIGNEE further agrees
that all replacements for equipment or apparatus will be made with identical or substantially like
items as approved by the CAL OES.
d. Nothing in this Agreement shall be construed to create a new property interest or
right of action for the ASSIGNEE.
19. UNAUTHORIZED USE OF CAL OES APPARATUS AND EQUIPMENT. Use of this Apparatus
other than as specified in Paragraph 1 will be considered a breach of this Agreement.
5 04/2012
Agreement for Temporary Assignment of Vehicular Equipment
State of California
GOVERNOR'S OFFICE OF EMERGENCY SERVICES
Fire and Rescue Division
20. USE OF RADIO EQUIPMENT
a. CAL OES will furnish at CAL OES'S sole cost, radio equipment installed in the
Apparatus to be operated on the following frequencies: 151.145 - 170.925 .
b. CAL OES agrees to maintain said equipment without cost to ASSIGNEE.
C. The ASSIGNEE agrees to operate said radio equipment in accordance with the
Rules and Regulations of the Federal Communications Commission.
d. Ownership of said equipment is in the CAL OES, and all applications to the
Federal Communications Commission seeking authority to add, modify, or replace radio
equipment covered by this Agreement shall be made by and in the name of the State of
California. To activate this Agreement and in compliance with the control requirements of the
Communications Act of 1934, as amended, the CAL OES hereby deputizes the Chief of the
agency of said ASSIGNEE, and such volunteers, regularly employed and salaried assistants as
shall be designated by the Chief of the agency as his agents to operate said radio equipment as
specified in Paragraph "c" above.
e. CAL OES assumes no liability hereunder for claims or losses accruing or
resulting to any person, firm or corporation furnishing or supplying work, services or material or
services in connection with the performance of this Agreement or for any claims and losses
accruing or resulting to any person, firm or corporation injured or damaged by performance of
either party hereunder.
21. NOTICES. All correspondence and notices required or contemplated, or which may be
given by either party to the other shall be deemed to have been fully given when made in writing
and deposited in the U.S. mail, registered and postage prepaid and addressed as follows: To the
ASSIGNEE at Huntington Beach Fire Department, 2000 Main St. — 5th Floor, Huntington
Beach, CA 92648, and to the CAL OES at Governor's Office of Emergency Services, Fire and
Rescue Division, 3650 Schriever Ave., Mather, CA, 95655. The address to which notices shall
or may be mailed as aforesaid to either party shall or may be changed by written notice given by
such party to the other, as hereinabove provided; but nothing herein contained shall preclude the
giving of any such notice by personal service.
22. ALTERATION. It is mutually understood and agreed that no alteration or variation of the
terms of this Agreement shall be valid unless made in writing and signed by the parties hereto,
and that no oral understanding or agreements not incorporated herein, and no alterations or
variations of the terms hereof unless made in writing between the parties hereto shall be binding
on any of the parties hereto.
23. WAIVER. The CAL OES may in its sole discretion and for such good cause as it
determines waive in writing in whole or in part any requirement of this Agreement that apparatus
and/or equipment shall be maintained in operating condition, or repaired, or replaced, providing
that any such waiver shall be applicable only to the specific apparatus or equipment to which it
refers.
24. JURISDICTION AND VENUE. This Agreement, and any dispute arising from the relationship
6 04/2012
Agreement for Temporary Assignment of Vehicular Equipment
State of California
GOVERNOR'S OFFICE OF EMERGENCY SERVICES
Fire and Rescue Division
between the parties to this Agreement,will be governed by the laws of the State of California.
25. WHOLE AGREEMENT. This Agreement constitutes the entire agreement between the
parties hereto, with respect to the subject matter hereof. No party has been induced to enter into
this Agreement by, nor is any party relying on, any representation or warranty outside those
expressly set forth in this Agreement.
IN WITNESS WHEREOF the parties hereto have executed this Agreement upon the date first
above written.
ASSIGNEE: CAL OES:
Huntington Beach Fire Department Mark Ghilarducci
Director,
Governor's Office of Emergency Services
By By
David Segura Fire Chief Brian SMarshall, State re and Rescue Chief
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7 04/2012
Agreement for Temporary Assignment of Vehicular Equipment
State of California
GOVERNOR'S OFFICE OF EMERGENCY SERVICES
Fire and Rescue Division
EXHIBIT"A"
EQUIPMENT INVENTORY: OES 360+
ENGINE LICENSE VIN
NUMBER:416 NUMBER: 1562260 NUMBER: 44KFT4281KWZ23237
Adapter,6"x 2-1/2",DF Hydrant 1 Reducer, 1-1/2"NH F to I"NPSH M
I Adapter,6"x 4",DF Hydrant 1 Reducer,2-1/2"NH F to 1-1/2"NH M
1 Adapter,6"x 4-1/2",DF Hydrant 1 Reflector Kit,3-Unit
1 Axe,Pickhead 2 Rope,1/2"x 100',Utility
2 Block,Chock 1 Shovel,Long Handle,Round Point,Fiberglass Handle
2 Cans,Fuel 1 Siamese,2-1/2"
4 Cap,2-1/2"Discharge 2 Soft Suction Hose,3"x 12'
1 Chain,Tow 25',w/Grab Hooks I Strainer,Class A Foam(in fill tower)
l Clamp,Hose(Hebert) I Strainer,1 '/2"Hard Suction Hose
2 Clamp,Hose(Wildland 1 Strainer,6"Hard Suction Hose
5 Cones,Traffic w/reflective band 4 Strap,Hose and Ladder
2 Coupling,2-1/2",DF 3 Tee,Wildland 1 %2"NH M/F x 1"NPSH
2 Coupling,2-1/2",DM 2 Wrench,Adjustable Hydrant
2 Cover,Salvage(Canvas) 2 Wrench, 1"/1-1/2",Forestry
1 Crank,Hose Reel 1 Wrench,Suction Hose Spanner
1 Cutter,Bolt,30" 4 Wrench,Hose Spanner
1 Fire Extinguisher,5# 1 Wye,Gated 2-1/2"NSF x 2-1 1/2"NSM
1 First Aid Kit ***************US&R INVENTORY:***************
1 Portable Pump,Cal OES#t81592 Serial#GCBRT-2094448 1 Axe,Flathead
1 Backpack,Thermo-Gel I Backboard,w/4 Straps
1 Thermo-Gel—Pick-up Tube 1 Backboard,Head Immobilizer
I Thermo-Gel—Eductor,Hose&Nozzle 2 Bar,Claw,Wrecking,3'
2 Thermo-Gel—Concentrate,5 Gal. 4 Bar,Pinch Point,Pry,60"
1 Generator w/light, 2,000 W, Cal OES# 181593 Serial# 3 Belt,Carpenter
EMAT-1086550 12 Blade,Hacksaw,Carbide
2 Hammer,Sledge,8-10 lb. 2 Blanket,Disposable
8 Hose, 1"x 100',NPSH 27 Carabiner,Locking,"D", I I nun
1 Hose,1-1/2"x 35',Truck Protection Line 1 Chainsaw,w/carbide chain and tool kit,Cal OES#181591
12 Hose,1-1/2"x 50',NH Serial#185340062
10 Hose,1-1/2"x 100',NH Forestry 2 Chisel,Cold, I"x 7-7/8"
24 Hose,3"x 50',NH 2 Chemical Light Kit
2 Hose,Booster I"x 100'NPSH 2 Cribbing&Wedge Kits
I Hose,Hard Suction 1 '/2"x 10' 2 Edge Protectors
2 Hose,Hard Suction 6"x 10' 1 Emergency Signaling Device(Whistle)
Hose,Soft Suction 6"x 12' 2 Friction Device,(Fig.8 w/Brake Bar Rack)
Increaser,V NPSH F to 1-1/2"NH M 2 Hacksaw
Intercom Set 2 Handsaw,Crosscut,26".
1 Ladder, 10'Attic 3 Hammer,Framing,24 oz
1 Ladder, 14'Roof 4 Hammer,Sledge,3-4 lb.,Short
1 Ladder,24'Extension 2 Harness,Body,Commercial(Class 2 or better)
4 Lantern,Hand, 12 Volt 2 Haul Bag
5 Lights,for Traffic Cones,flashing amber 2 Jack,Hydraulic w/Handle(8 ton)
1 Log Book,w/Credit Card 2 Kernmantle,'/2"x 150',Static,NFPA Approved
1 Mallet,Rubber I Knife,Utility
2 McCleod/Thou Claw 3 Level,6"
1 Mount,Ground,Deluge 1 Litter&Litter Cover
4 Nozzle,I",Combination I Litter Pre-rig
5 Nozzle, 1 '/2",Combination(2 structural/3 wildland) 2 Load Release
1 Nozzle, Deluge Set w/Stream Straightener and Tips 1-3/8", 6 pr Loop,Prusik
1-1/2",1-3/4",2" 1 Marking Kit,Building
1 Nozzle,Deluge Combo,500—1,250 gpm 2 Multipoint Collection Plate
1 Nozzle, 1 '/2",Foam,Air Aspiration 3 Nails,(25 lbs.Each: 16d,8d)
1 Nozzle,2'/2",Fog 6 Picket,Steel, 1"x 4'
2 Nozzle,2'/2",Shutoff w/Tips 3 Pulley,Rescue,Prusik Minding
1 Cal OES Operations/Maintenance Bulletins l San Francisco Hydrant Adaptor,3"NHF to 2%2"NHM
2 Pike Pole(6'&8') 1 Shovel,Scoop,"D"Handle,Fiberglass Handle
2 Plug,2-1/2"Suction 1 Shovel,Long Handle,Square Point,Fiberglass Handle
I Pulaski 3 Square,(Tri or Speed)
1 Radio,Bendix-King,Handheld I Square,Framing,24"'
Serial#1005030118300039 3 Tape Measure,25'
Cal OES#181590 2 Tape,Barrier
DGS#SHZ879 2 Tape,Duct
1 Radio,Kenwood,Mobile Serial#B8830033 I Took Kit
Cal OES#181589 1 Trauma Kit
DGS#SHZ878 I Webbing Kit,(6 ea: 1"x5', 1"x 12', 1"x 15',1"x20')
REMARKS:
ACCEPTED BY: TITLE:
DEPARTMENT: DATE:
A-1 4/2012
Agreement for Temporary Transfer of Vehicular Equipment
State of California
GOVERNOR'S OFFICE OF EMERGENCY SERVICE
Fire and Rescue Division
EXHIBIT`B"
TEMPORARY CAL OES APPARATUS ASSIGNMENT RECORD
NO. A R'T I C L E , CAL OES QUANTITY
1. 1,250 gpm Triple Combination Fire Engine, complete Cal OES 1
with equipment per attached Exhibit "A" of Agreement for 416
Temporary Transfer of Vehicular Equipment.
2. License No: 1562260
3. VIN No: 44KFT4281KWZ23237
4. Engine No: 416
5. Proof of Insurance:
6. Inventory Completed:
7.
8.
9.
10.
11.
REASON FOR TEMPORARY TRANSFER: New Assignee
SIGNATURES:
Date
PERMANENT ASSIGNEE
Date
TEMPORARY ASSIGNEE
B-1 4/2012
Agreement for Temporary Transfer of Vehicular Equipment
State of California
GOVERNOR'S OFFICE OF EMERGENCY SERVICE
Fire and Rescue Division
EXHIBIT"C"
INSURANCE REQUIREMENTS
Part of the Agreement through which the State makes a temporary transfer of vehicular equipment is the
Agreement on the part of the ASSIGNEE to furnish certain evidence of insurance. Your organization, as
an ASSIGNEE of equipment, will want to be mindful of these requirements and assure they are complied
with. If self-insured, in lieu of a certificate of insurance, a written statement of self-insurance shall be
furnished on official letterhead and agreeing to hold Cal OES harmless from any personal injury or
property damage claims arising out of the maintenance,use or operation of the Apparatus.
Liability Insurance
A certificate of insurance shall be furnished to the State providing minimum limits of insurance as
follows:
BODILY INJURY and PROPERTY DAMAGE LIABILITY$1,000,000.00 PER OCCURENCE
A certificate of insurance will have the following provisions included:
1. The State of California shall be named Additional Insured.
2. The insurance company shall agree that in the event of cancellation, 15 days prior written
notice will be given to the State.
3. The State shall not be responsible for premium or assessments.
4. Certificate of Insurance must include the description of the Apparatus including identification
number, State license number and Cal OES unit number.
Physical Damage Insurance
The transfer agreements place certain responsibilities upon your organization for the safekeeping of the
vehicle and equipment. The State will look to your organization for reimbursement for repair or
replacement cost in the event the vehicle or equipment is damaged by misuse or negligence or by other
causes, except normal wear and tear, acts of God and conditions over which your organization has no
control.
Description of Apparatus
VEHICLE VALUE
2019 HME Type I Engine $379,598.53
License Number: 1562260
VIN Number: 44KFT4281KWZ23237
Engine Number: 416
EQUIPMENT
Hose and Appliances $38,000.00
C-1 4/2012
Agreement for Temporary Transfer of Vehicular Equipment