Form FEMA Form 080-3 FEMA Form 080-3 Activity Specific Questions for AFG Vehicle Applicants

O.M.B. No. 1660-0054

FF 080-3

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Activity Specific Questions for AFG Vehicle Applicants

Firefighting Vehicle Program

Please provide the following information about the vehicle you want funded. See list of eligible vehicles in the next section. If your organization is applying for equipment and a vehicle, you must fill out a separate application for each.

Note: Fields marked with an * are required.

Vehicle Details
* 1. What type or class of vehicle will you use the grant funds to purchase? (select one from list of Firefighting Vehicle Types on page 35)
Please provide further description of the item selected above or if you wrote Other above, please specify.
* 2. Cost (whole dollar amounts only)	$
* 3. Is the vehicle you propose to buy a refurbished, used or new response vehicle to meet current standards?	○ New ○ Refurbished (compliant to current standards) ○ Refurbished (compliant to the year of manufacturing) ○ Used (compliant to the year of manufacturing)
* 4. What is the newest (age) vehicle you currently own in the class you are purchasing?	○ N/A ○ 1 year ○ 2 years ○ 3 years	○ 4 years ○ 5 years ○ 6 years ○ 7 years	○ 8 years ○ 9 years ○ 10 years ○ 11 years	○ 12 years ○ 13 years ○ 14 years ○ 14+ years
* 5. How old is the oldest (age) vehicle you own in the class you are purchasing?	○ N/A ○ 1 year ○ 2 years ○ 3 years ○ 4 years ○ 5 years ○ 6 years	○ 7 years ○ 8 years ○ 9 years ○ 10 years ○ 11 years ○ 12 years	○ 13 years ○ 14 years ○ 15 years ○ 16 years ○ 17 years ○ 18 years	○ 19 years ○ 20 years ○ 21 years ○ 22 years ○ 23 years ○ 24 years ○ 24+ years
* 6. What is the average age of all vehicles in your fleet?	○ N/A ○ 0-4 ○ 5-7 ○ 8-10 ○ 11-14 ○ 15-19 ○ 20+
*7. Do you have a formal driver-training program?	○ Yes ○ No

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8. If not, will you be requesting funding under this application for driver training or will you obtain the appropriate training through other sources?	○ Yes ○ No
*9. Is the vehicle you propose to buy:	○ First time purchase for new mission (do not currently own) ○ Replacement of an existing apparatus ○ Addition to the fleet ○ For time purchase for the existing mission (do not currently own)
*10. Is the vehicle you are replacing a converted vehicle not originally designed for its current use?	○ Yes ○ No ○N/A - First Time Purchase
*11. Does the vehicle you are replacing have an open cab configuration?	○ Yes ○ No ○N/A - First Time Purchase
*12. If awarded, will you permanently remove this substandard vehicle from service?	○ Yes ○ No
*13. Will this vehicle be used for automatic and/or mutual aid?	○ Automatic Aid ○ Mutual Aid ○ Both ○ None
*14. What percentage of your annual budget goes to vehicle replacement?	(0-100%)

Firefighting Vehicle Types (select one for Vehicle Details Q1)

Engine
Pumper
Foam Pumper
CAFS Pumper
Quint (Aerial device of less than 76 feet)
Type I Engine
Tanker
Tanker
Foam Tanker
Tender
Foam Tanker/Tender
Type I, Type II, Type IV Engine
Brush/Attack
Brush Truck
Patrol Unit (Pick up w/Skid Unit)
Mini-Pumper
Type II, IV, V, VI, VII Engine
Aerial
Aerial Ladder Truck
Telescoping
Articulating
Ladder Towers
Platforms
Tiller Ladder Truck
Quint (Aerial device of 76 feet or greater)
Rescue (non-transport)
Rescue (Light, Medium, Heavy)	Technical Rescue Vehicle
Other/Specialized Vehicles
Ambulance	Hazardous Materials Unit
ARFF (Aircraft Rescue Firefighting)	Air/Light Unit
Command/Mobile Communications Vehicle	Other Vehicle

Firefighting Vehicle Inventory

Please provide the following information.

If you have 15 emergency response vehicles or less, list all vehicles providing the type, the age, the pump capacity (GPM) if applicable, the carrying capacity (gallons) if applicable.

Vehicle	Type (possible terms: Engine or Pumper, Tanker, Aerial Apparatus, Brush/Quick Attack, Rescue Vehicles, or Other)	Year	GPM	Gallons
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

If you have more than 15 emergency response vehicles, please provide the oldest, newest, and average age for each type of vehicle.

Type or Class	Quantity	Oldest (age)	Newest (age)	Average (age)
Engines (or Pumpers)
Tankers
Aerial Apparatus
Brush/Quick attack
Rescue Vehicles
Other Vehicles

Firefighting Vehicle - Additional Funding (optional)

Please add any additional funding for your grant in the space provided below. You will need to explain the additional costs.

Additional Funding
a. Personnel	$
b. Fringe Benefits	$
c. Travel	$
d. Equipment	$
e. Supplies	$
f. Contractual	$
g. Construction	$
h. Other	$
i. Indirect Charges	$
Explanation (Attach an additional sheet if necessary)

Once you have completed the Request Details, please go to page 74 for the budget.

EMS Vehicle Program

Please provide the following information about the vehicle you want funded. If your organization is a fire department, go to page 33.

Note: Fields marked with an * are required.

EMS Vehicle Details
* 1. What type or class of vehicle will you use the grant funds to purchase?	○ Ambulance ○ Transport unit to support EMT-B ○ First responder non-transport vehicles ○ Special operations vehicles ○ Helicopters/planes ○ Command vehicles ○ Hovercraft ○ EMS Chase Vehicle ○ Other special access vehicles
Please provide further description of the item selected above or if you selected Other above, please specify.
* 2. Cost (whole dollar amounts only)	$
* 3. Is the vehicle you propose to buy a refurbished, used or new response vehicle to meet current standards?	○ New ○ Refurbished (compliant to current standards) ○ Refurbished (compliant to the year of manufacturing) ○ Used (compliant to the year of manufacturing)
* 4. What is the newest (age) vehicle you currently own in the class you are purchasing?	○ N/A ○ 1 year ○ 2 years ○ 3 years	○ 4 years ○ 5 years ○ 6 years ○ 7 years	○ 8 years ○ 9 years ○ 10 years ○ 11 years	○ 12 years ○ 13 years ○ 14 years ○ 14+ years
* 5. How old is the oldest (age) vehicle you own in the class you are purchasing?	○ N/A ○ 1 year ○ 2 years ○ 3 years ○ 4 years ○ 5 years ○ 6 years	○ 7 years ○ 8 years ○ 9 years ○ 10 years ○ 11 years ○ 12 years	○ 13 years ○ 14 years ○ 15 years ○ 16 years ○ 17 years ○ 18 years	○ 19 years ○ 20 years ○ 21 years ○ 22 years ○ 23 years ○ 24 years ○ 24+ years

(continued on next page)

(continued from previous page)

* 6. What is the average age of all vehicles in your fleet?	○ N/A ○ 0-4 ○ 5-7 ○ 8-10 ○ 11-14 ○ 15-19 ○ 20+
*7. Do you have a formal driver-training program?	○ Yes ○ No
If not, will you be requesting funding under this application for driver training or will you obtain the appropriate training through other sources?	○ Yes ○ No
*8. Is the vehicle you propose to buy:	○ First time purchase for new mission (do not currently own) ○ Replacement of an existing apparatus ○ Addition to the fleet ○ First time purchase for the existing mission (do not currently own)
*9 Is the vehicle you are replacing a converted vehicle not originally designed for its current use?	○ Yes ○ No ○N/A - First Time Purchase
*10. If awarded, will you permanently remove this substandard vehicle from service?	○ Yes ○ No
*11. Will this vehicle be used for automatic and/or mutual aid?	○ Automatic Aid ○ Mutual Aid ○ Both ○ None
*12. What percentage of your annual budget goes to vehicle replacement?	(0-100%)

EMS Vehicle Inventory

Please provide the following information.

If you have 15 emergency response vehicles or less, list all vehicles providing the type, the age, the pump capacity (GPM) if applicable, the carrying capacity (gallons) if applicable, and number of riding positions.

Vehicle	Type (possible terms: Ambulance, Rescue Vehicle, Other)	Year	GPM	Gallons
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

If you have more than 15 emergency response vehicles, please provide the oldest, newest, and average age for each type of vehicle.

Type or Class	Quantity	Oldest (age)	Newest (age)	Average (age)
Ambulance
Rescue Vehicle
Other Vehicles

EMS Vehicle - Additional Funding (optional)

Please add any additional funding for your grant in the space provided below. You will need to explain the additional costs.

Additional Funding
a. Personnel	$
b. Fringe Benefits	$
c. Travel	$
d. Equipment	$
e. Supplies	$
f. Contractual	$
g. Construction	$
h. Other	$
i. Indirect Charges	$
Explanation (Attach an additional sheet if necessary)

Please continue to Budget on page 74.